A new Serious Incident Response Scheme (SIRS) is scheduled to be in force by July 2021. Here’s what we know and how you can prepare.

Key Points

The framework is not concrete and finer details need to be finalised. What we know so far, is that:

• reporting under a SIRS will include a broader range of incidents, including neglect, psychological or emotional abuse and inappropriate physical or chemical restraint
• the current exemption on reporting resident on resident abuse, where the perpetrator has an assessed cognitive impairment, will be removed
• the Aged Care Quality and Safety Commission will receive incident reports and will have enhanced powers to take regulatory action where needed.

The Current Reporting Scheme

The Aged Care Act 1997 (Cth) currently requires approved providers of residential aged care to report incidents of alleged or suspected ‘reportable assaults’ against a resident to the Department within 24 hours (section 63-1AA(g)).

A ‘reportable assault’ involves any:

• Unlawful sexual contact, which is defined as any non-consensual sexual contact, including where the resident cannot give informed consent by reason of assessed cognitive or mental impairment; and/or
• Unreasonable use of force, which is intended to capture any use of unwarranted physical contact on residents, regardless of whether it causes visible harm (e.g. bruising).

Providers do not have to report a ‘reportable assault’ if:

• the alleged assault is perpetrated by a resident who had an assessed cognitive or mental impairment at the time, and care arrangements are put in place to manage the behaviour within 24 hours; or
• the allegation or suspicion is related to the same, or substantially the same, factual situation as an earlier allegation or suspicion of a reportable assault that has already been reported to the Department (63-1AA(3); Accountability Principles 2014 (Cth) s 53).

But inquiries by independent bodies into the effectiveness of the current scheme have raised doubts about whether it creates a tight enough net to protect older persons. Serious incidents and abuse and neglect might fall through the gaps and there is a lack of oversight into providers’ responses to reportable assaults.

The Proposed Serious Incident Response Scheme (‘SIRS’)

The Commonwealth Government engaged accounting firm KPMG to conduct an independent study on the prevalence of resident on resident incidents in residential aged care facilities nationally. This, and other reviews and recommendations dating from 2017 to 2019 were used to develop a public consultation paper. This consultation paper provided a more detailed framework for the SIRS.

Here are the key findings from the Public Consultation and the KPMG study:

The Proposed Definitions and ‘Serious Incident’ Threshold

In general, submitters thought the definitions need to:

• be clearer and more objective such that reporting an incident would not require subjective interpretations or judgement calls
• be consistent with existing state and territory regulatory frameworks
• provide better guidance on reporting thresholds involving ‘challenging scenarios’, including those that are dementia specific or involve more ‘borderline’ behaviour
• establish an overall objective that shifts focus away from the ‘reporting’ part of serious incidents, to effectively responding, managing and preventing serious incidents.

Other key points from the submission include:

• support for removing the assessed cognitive or mental impairment exception
• differing opinions on whether financial abuse should be included in the SIRS.

To read the full list of proposed definitions and the feedback, refer to pages 10 – 22 of the Public Consultation Paper.

Who Should Be Required to Report?

Submissions were split between:

1. Delegating responsibility to one key member of the executive team or governing body, such as a CEO or Facility Manager; or
2. Having more than one person in charge of the reporting role as it might provide a more balanced and impartial approach to reporting.

Timeframes for Reporting

In general, the proposed timeframes for reporting were considered reasonable. That is:

• 24 hours for incident notification
• 5 business day for the provision of an incident status report
• 60 business days for a final report.

There were submissions that felt the reporting timeframes were insufficient to report meaningful information, and the requirement of three reports could be burdensome for both providers and regulators.

A solution might be to introduce a mechanism that allows flexibility for reporting timeframes in particular circumstances.

Information that Should be Reported

A key component of the scheme is what should be included in providers’ reports at each of the three stages: incident notification, incident status report and final report.

The paper highlighted the following recommendations from submissions:

• diagnosis of cognitive impairment as assessed by a health professional (long or short term, sudden onset, etc.)
• information regarding the cognition of both residents/consumers (suggesting that both are likely to have contributed to the incident, such that there won’t always be one perpetrator and one victim)
• details of behavioural intervention strategies/support plan referral to support services.

In general, details of the incident report should provide a more wholistic picture of the incident. Submissions also flagged the need to address confidentiality and privacy issues.

Public Reporting

Although the consensus was that pubic reporting should occur at some stage, some suggested that SIRS information should only be publicly reported if it is risk-adjusted for a providers’ consumer matrix as consumer characteristics may affect the rate of SIRS reports (e.g. consumers with dementia or a mental health diagnosis or complex clinical care needs). It was also suggested that there should be no public reporting until the SIRS is determined to be fair and robust.

Record Keeping

No change was proposed to the existing record keeping requirements and submissions agreed the current requirements were sufficiently robust.

Compliance and enforcement

Submissions expressed:

• preferences for penalties to be applied to both individuals and approved providers because perpetrators should be held accountable, and providers with a history of repeated offences should be penalised
• for the Commission to have their powers broadened to enable better collaboration with other government agencies, such as the police and AHPRA, for the purpose of protecting consumers from abuse.

What Now?

There are likely to be further studies and/or consultations before the SIRS is finalised. The public consultation involved submissions from aged care provider peak bodies, consumer advocacy organisations and peak bodies, approved providers of residential care, and from state and territory governments so it is likely to be influential in the development of the final SIRS.

So far, we can be fairly certain that:

• the exception to reporting alleged assaults perpetrated by a resident with an assessed cognitive or mental impairment will be removed
• ACQSC powers will be broadened.

What we need to keep an eye on is the extent of providers’ reporting obligations as the ‘serious incident’ threshold and definitions seem to require more extensive work.

Providers can still begin preparations for the SIRS, as 12 months sounds like a long time but can pass in the blink of an eye:

• Review your internal incident reporting systems – are they sufficiently accessible by persons who can make a report?
• Have you got clear reporting procedures, that all staff have been trained on?
• Have responsibilities for reporting been delegated?
• Are there policy review procedures in place to ensure your internal reporting policies can be updated efficiently when the changes come?
• Does your internal incident system provide you with the data, information and reports required to ensure timely and appropriate system improvements and expected resident outcomes?