Aged Care Essentials | Serious Incident Response Scheme (SIRS)

According to The Department of Health, the new Serious Incident Response Scheme (SIRS) commences 1 April 2021. Here’s what residential aged care providers need to know.

What is the Serious Incident Response Scheme (SIRS)?

The SIRS is a national framework for incident management and reporting of serious incidents in residential aged care. It imposes obligations on aged care providers to manage and report on incidents, and expands the powers of the Aged Care Quality and Safety Commission (ACQSC).

Overview of SIRS Requirements

The SIRS imposes two main requirements on residential aged care providers/services:

• Incident management system: from 1 April 2021 every residential aged care service must have in place an effective incident management system. An “effective incident management system” means “a set of protocols, processes, and standard operating procedures that staff are trained to use.”
• Compulsory reporting obligations: from 1 April 2021 every residential aged care service must report certain “Priority 1 serious incidents” to the Aged Care Quality and Safety Commission (ACQSC) and sometimes to the police as well. From 1 October 2021, services must also report certain less serious “Priority 2” incidents.

Incident Management System

From 1 April 2021 every residential aged care service must have in place an effective incident management system. According to the ACQSC’s Best Practice Guidance, “an incident management system is not a spreadsheet with a record of incidents. Rather, it is a comprehensive approach to preventing, managing and learning from incidents.” An effective incident management system:

• requires leadership commitment and an organisational culture that values openness, accountability and continuous improvement in quality and safety
• must exist within a clear governance framework
• should include comprehensive policies and procedures relating to incidents and near misses,
• and their management
• should include a mechanism that enables all incidents (whether or not they are reportable) to be easily recorded, safely and securely stored, and easily accessed
• must be well understood and utilised by staff
• must enable you to respond to incidents including to:
  • identify and respond to an incident including immediately supporting those affected
  • report the incident, make necessary notifications and record the incident appropriately
  • review, analyse and, if necessary, investigate how and why it happened
  • implement changes to reduce the risk of recurrence and to make aged care safer
• support you to continuously improve, share learnings and analyse trends
• should regularly be reviewed.

Compulsory Reporting Obligations

What do we have to report?

From 1 April 2021, if any of these “reportable incidents” occur at your aged care home you must report them:

• Unreasonable use of force – for example, hitting, pushing, shoving, or rough handling.
• Unlawful sexual contact or inappropriate sexual conduct – such as sexual threats or stalking, or sexual activities without consent.
• Psychological or emotional abuse – such as yelling, name calling, ignoring a consumer, threatening gestures, or refusing a consumer access to care or services as a means of punishment.
• Unexpected death – in the event of a fall, untreated pressure injury, or the actions of a consumer result in the death of another consumer.
• Stealing or financial coercion by a staff member – for example, if a staff member coerces a consumer to change their will to their advantage, or steals valuables from the consumer.
• Neglect – includes withholding personal care, untreated wounds, or insufficient assistance during meals.
• Inappropriate physical or chemical restraint – for example, where physical or chemical restraint is used without prior consent or without notifying the consumer’s representative as soon as practicable; where physical restraint is used in a non-emergency situation; or when a provider issues a drug to a consumer to influence their behaviour as a form of chemical restraint.
• Unexplained absence from care – this occurs when the consumer is absent from the service, it is unexplained and has been reported to the police.

You must report these incidents even if:

• the incident is only suspected or alleged
• the incident involves a care recipient with cognitive or mental impairment (such as dementia)
• you are uncertain about whether an incident should be reported (i.e. if uncertain, you should err on the side of caution and report the incident).

What is not a reportable incident?

• An incident that results from the residential care recipient deciding to refuse to receive care or services offered by the approved provider.
• Gentle touching done for the purposes of care.
• Consensual sexual touching between a resident and someone who is not a staff member or a volunteer providing care.
• Physical restraint or chemical restraint that is used in a transition care program in a residential care setting and is used in the circumstances set out in sections 15F and 15G of the Quality Care Principles (assuming that those sections applied to the residential care recipient in relation to that care).

(See the new sections 15NA and 15NB of the Quality of Care Principles 2014).

Who must report?

The law says that “approved providers” must report under the SIRS. But which specific people in your home are the “approved providers”? The law is not clear on this. At this stage you should take a broad view and assume that your governing body/board and leadership and management team all have a general responsibility to ensure that the ACQSC (and sometimes police) are notified of reportable incidents. You should also nominate a specific person as being chiefly responsible for reporting. This person should work with a team of responsible reporters so that for all seven days of the week someone is available and qualified to make a report. You should ensure that these people have access to the My Aged Care Portal.

Your general staff do not have a responsibility to report to the ACQSC or police. However, all “approved providers” have a responsibility to ensure that “a staff member of the provider who becomes aware of a reportable incident notifies one of the following of that fact as soon as possible”:

• one of your key personnel
• a supervisor or manager of the staff member
• the person who has been delegated the responsibility of reporting.

(See the new section 15ND of the Quality of Care Principles 2014).

When must we report to the ACQSC?

If one of your general staff becomes aware of a reportable incident, they must report it “as soon as possible.”

If an “approved provider” (i.e. leadership, senior staff, management) becomes aware of a reportable incident, the deadline for reporting will depend on the kind of incident:

• Priority 1 incidents must be reported to the ACQSC within 24 hours of becoming aware of the incident. A “Priority 1 incident” occurs where the incident has caused, or could reasonably have caused, a care recipient physical or psychological injury or discomfort that requires medical or psychological treatment to resolve. Unexplained absence from care and unexpected are always to be regarded as Priority 1 incidents.
• Priority 2 incidents must be reported to the ACQSC within 30 days of becoming aware of the incident. This includes all other reportable incidents that do not meet the criteria for a Priority 1 incident. This obligation applies from 1 October 2021.

When must we report to police?

Reporting to the police is an additional obligation. You still have to report to the ACQSC even if you report to police.

If there are “reasonable grounds” to believe that the incident should be reported to the police, it must be reported within 24 hours of becoming aware of the incident. “Reasonable grounds” is not a clearly defined term, but it roughly means that if you believe a person is missing or a crime is involved (e.g. assault or theft) you must report to police. If you later realise that an incident should have been reported to police, then you have 24 hours from the moment of your realisation. (See the new section 15LA of the Quality of Care Principles 2014).

How do we report?

Reports to the ACQSC are made via the My Aged Care Provider Portal.

Reports to police are made by calling triple-zero (000) in an emergency or otherwise by phoning your local police station.

What information do we need to include in a report?

• the name and contact details of the provider and service
• the name, position and contact details of the person making the notification
• a description of the reportable incident (including the kind of incident)
• a description of the harm caused (or that could have been caused) to the consumer(s) affected by the incident and the consequences of that harm (including if a death has occurred)
• the immediate actions taken in response to the reportable incident, including actions taken to ensure the health, safety and well-being of the consumer(s) affected by the incident
• whether the incident has been reported to police or any other body (including the coroner).

(See Aged Care Quality and Safety Commission: Frequently Asked Questions).

Issues and Complications

The SIRS is new and complicated. Here are some key points to note:

Reportable incidents include acts perpetrated by consumers with a cognitive impairment (e.g. dementia)

Before the SIRS, there was a “reporting exemption” that applied to acts committed by consumers with an assessed cognitive impairment. In broad terms, this meant that if a consumer with an assessed cognitive impairment did an act involving unreasonable use of force or unlawful or inappropriate sexual contact, the provider was not required to report it. Under the SIRS, that exemption will not apply. Aged care providers will have to report the incident, regardless of the consumer’s cognitive impairment.

Reportable incidents of “psychological or emotional abuse” will include patterns of behaviour

Under the SIRS, “psychological or emotional abuse” will include incidents that may not be “serious” on their own but which, due to their repetition over time, have a cumulative impact that causes significant harm to the consumer.

When do you “become aware” of an incident?

Aged care providers must report a Priority 1 incident within 24 hours of “becoming aware” of the incident. Does this mean 24 hours from when a general staff member witnesses the incident? Or 24 hours from when the staff member reports the incident to a manager? Or 24 hours from when the incident is logged in your system?

As noted above, the reporting obligation applies to “aged care providers” not to general staff. So it seems that the clock starts ticking as soon as anyone in the management or leadership team becomes aware of the incident. For example, if a staff member witnesses a resident being bullied at 1.45pm and reports this to their manager at 2.15pm, then the clock starts at 2.15pm and the incident must be reported by 2.15pm the following day.

Note: under the SIRS, all providers have an obligation to ensure that staff report incidents to management “as soon as possible”. So, in the above example, if the staff member waited too long before reporting the bullying incident to management, the aged care provider may have breached their obligations under the SIRS.

What Now?

• Review your internal incident reporting systems – are they sufficiently accessible by persons who can make a report? Is there an escalation process in the incident reporting process to ensure timely notification of the right people (e.g. management team)?
• Have you got clear reporting and recording procedures that all staff have been trained on?
• Have responsibilities for reporting been delegated? Nominate a specific person as being chiefly responsible for reporting. This person should work with a team of responsible reporters so that for all seven days of the week someone is available and qualified to make a report. You should ensure that these people have access to the My Aged Care Portal.
• 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?
• In conjunction with this, do these systems and the recorded information support the SIRS reporting process?

Most importantly, remember: the SIRS is not just about how well you respond to a particular incident. It is about the kinds of systems and processes you have in place.

Further Resources

• Department of Health: Serious Incident Response Scheme
• Serious Incident Response Scheme – Guidelines for residential aged care providers
• Effective incident management systems: Best practice guidance
• Quick Reference Guide: How to access and use the Serious Incident Response Scheme (SIRS) portal
• Aged Care Quality and Safety Commission: Frequently Asked Questions 

ABOUT THE AUTHORS

Mark Bryan

Mark is a Legal Research Consultant at CompliSpace and the editor for ACE. Mark has worked as a Legal Policy Officer for the Commonwealth Attorney-General’s Department and the NSW Department of Justice. He also spent three years as lead editor for the private sessions narratives team at the Royal Commission into Institutional Responses to Child Sexual Abuse. Mark holds a bachelor’s degree in Arts/Law from the Australian National University with First Class Honours in Law, a Graduate Diploma in Writing from UTS and a Graduate Certificate in Film Directing from the Australian Film Television and Radio School.

Jenny Wang

Jenny is the Content Integration Team Leader at CompliSpace and a legal research assistant for the aged care team. She has a Bachelor of Science (Financial Mathematics and Statistics) and is currently completing her Bachelor of Laws at the University of Sydney.