From 1 October 2021, Priority 2 incidents must be reported under the Serious Incident Response Scheme (SIRS). Here’s what residential aged care providers need to understand and start preparing.

What Is the Serious Incident Response Scheme (SIRS)?

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

What Does the SIRS Require?

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

• Incident management system: from 1 April 2021 the SIRS required every residential aged care service to have an effective incident management system in place. 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 the SIRS required every residential aged care service to report certain “Priority 1 serious incidents” to the ACQSC and sometimes to the police as well. From 1 October 2021, services must also report certain less serious “Priority 2” incidents.

When Did the SIRS Commence?

While the SIRS mandatory reporting requirements for Priority 1 incidents commenced 1 April 2021, the requirement to report “Priority 2” incidents commences 1 October 2021.

What Sort of Incidents Do We Have to Report? (What Is a “Reportable Incident”?)

Aged care providers/services must report the following types of incidents to the ACQSC:

• Unreasonable use of force
• Unlawful sexual contact or inappropriate sexual conduct
• Psychological or emotional abuse
• Unexpected death
• Stealing or financial coercion by a staff member
• Neglect
• Inappropriate physical or chemical restraint
• Unexplained absence from care

What Is the Difference Between a “Priority 1 Reportable Incident” and a “Priority 2 Reportable Incident”?

Reportable incidents are divided into:

• Priority 1 incidents, and
• Priority 2 incidents.

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. Priority 1 incidents also include incidents where there are reasonable grounds to contact the police. Unexplained absence from care and unexpected death are always to be regarded as Priority 1 incidents.

A “Priority 2 incident” includes all other reportable incidents that do not meet the criteria for a Priority 1 incident.

This usually includes reportable incidents that result in a low level of harm to recipients, for instance, where a care recipient is briefly shaken or upset, or experiences temporary redness or marks that do not bruise. Incidents where medical treatment is not required are also likely to be Priority 2 incidents. The obligation to report Priority 2 incidents applies from 1 October 2021.

In circumstances where you are unsure whether the harm to the care recipient is low, or the recipient experiences ongoing distress or concern, it may be reasonable to assess the incident as a Priority 1 incident.

To support this decision making, the Serious Incident Response Scheme reportable incidents workflow published by the ACQSC is a useful resource.

Who Must Report?

The obligation to report applies to all “approved providers”. This effectively means that the obligation to report applies to all residential care homes. But an abstract entity such as an “approved provider” or “residential care home” cannot perform a task like reporting. Such tasks must be performed by a particular person or persons.

Which particular person or persons at your home are obliged to make the SIRS reports? Unfortunately, there is no official guidance on this. So, at this stage, you should take a broad view and assume that the reporting responsibility applies to your governing body/board and leadership and management team.

All “approved providers” (i.e. your governing body/board and leadership and management team) also have a responsibility to ensure that any staff member who becomes aware of a reportable incident notifies senior staff “as soon as possible.”

When Must We Report to the ACQSC?

The identification of an incident as either a Priority 1 incident or a Priority 2 incident will dictate when you must report an incident to the ACQSC.

Priority 1 incidents must be reported to the ACQSC within 24 hours of becoming aware of the incident.

Priority 2 incidents must be reported to the ACQSC within calendar 30 days of becoming aware of the incident.

When Must We 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. Note: reporting to the police is an additional obligation. You still have to report to the ACQSC even if you report to police.

How Do We Report?

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

Reports to police are made by calling them directly in an emergency or otherwise by phoning your local police station.

Do We Have to Report Incidents Involving Residents with Cognitive Impairment (e.g. Dementia)?

You must inform the ACQSC of all reportable incidents, including those that involve care recipients with cognitive impairments such as dementia.

However, you may be able to apply for an exemption. Section 95D of the Aged Care Quality and Safety Commission Rules 2018 (Cth) states that the Commissioner may decide that an approved provider is not required to give notice about a reportable incident if they are satisfied that, as a result of a care recipient’s delusion, a care recipient repeatedly alleges that the same incident has occurred.

But note, you must report the first incident, and if the same person is involved in a new incident the exemption does not apply and you must report the new incident.

Do We Have to Report Incidents that Occur Off Site?

Yes. The SIRS require you to report all reportable incidents that occur “in connection with” the provision of care. For example, if the incident occurs while staff are taking residents off site for an appointment it must be reported.

When Does a Person “Become Aware” of an Incident?

Aged care providers must report a Priority 2 incident within 30 calendar days of “becoming aware” of the incident. At exactly what point does someone “become aware” of an incident?

As noted above, the reporting obligations apply to “aged care providers” not to general staff, so our best guess is that the clock starts ticking as soon as an “aged care provider” (i.e. a member of the management or leadership team) becomes aware of the incident or has a suspicion of an 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 (Priority 1) must be reported by 2.15pm the following day.

Similarly, if a staff member observes that a resident is momentarily shaken on 1 June and notifies their supervisor of this on the following day (i.e. 2 June), then a provider would presumably have “become aware” on 2 June and have 30 calendar days from this date to report the incident. It is important to remember these are “calendar days” and not business days.

However, given that staff are the ones most likely to become aware of an incident first (for example, by witnessing an incident or signs of possible abuse, or receiving information from care recipients directly), providers have an obligation to ensure that staff are taught how to recognise and report incidents.

What Will the ACQSC Do in Response to an Incident Report?

The ACQSC has some specific powers it can use in response to a particular report and some general powers to gather and use data from a collection of reports.

Specific powers

When the ACQSC receives a notification of a reportable incident, it can:

• require the provider to give it information, further reports or documents
• request the provider to complete remedial actions in relation to the incident
• request the provider or an independent expert to undertake an internal investigation into the incident and report to the ACQSC
• conduct an inquiry in relation to a particular reportable incident or series of reportable incidents (whether or not a notification was made)
• refer the reportable incident to another responsible body, including the police or the Coroner.

The ACQSC also has the following powers of enforcement:

• issue a compliance notice where a provider is not, or may not be, complying with its incident management responsibilities
• ask a court to impose a civil penalty for a breach of the Commission Act or Aged Care Act (under the SIRS a civil penalty applies if the provider fails to comply with a compliance notice)
• seek an injunction from a court
• issue an infringement notice in certain circumstances (for example, causing detriment to a person who has made a disclosure regarding a reportable incident)
• impose sanctions under Part 7B of the Aged Care Quality and Safety Commission Act 2018 (Cth)
• accept a written undertaking (enforceable by court order) given by a provider that it will take specified actions to comply with its responsibilities and/or will take specified actions to ensure that these responsibilities are not contravened in the future.

General powers and responsibilities

The ACQSC will use the incident reports it receives to:

• assess and respond to a provider’s compliance with incident management obligations
• apply risk-based monitoring of how providers investigate and respond to reportable incidents
• make use of the high volume of intelligence to support risk profiling and identification of emerging trends in the sector
• provide feedback to the sector to support understanding of adverse events and support continuous improvement by providers in the quality and safety of care
• enhance transparency of quality and safety performance through sector performance reporting.

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
• SIRS Learning Module on ALIS
• SIRS Provider Resources: this contains a range of resources including webinars and videos to support aged care providers with understanding their requirements under the SIRS.