On 27 May 2021, the Aged Care Quality and Safety Commission (the Commission) updated its Serious Incident Response Scheme – Guidelines for residential aged care providers.

The Commission provided a summary of the updates on page 3 of the new guidelines. However, this summary is brief and does not mention all of the updates. So we’ve made a detailed comparison of the old version and the new version of the guidelines to provide you a more comprehensive list of what’s changed.

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 Commission.

What has Changed in the 27 May 2021 Updates?

Overview of key changes

• “Priority 2 reportable incident” is now defined as “An incident that does not meet the criteria for a Priority 1 incident”.
• “Duty of care” now has a narrower, more precise definition.
• Unexpected death: new guidelines state that not all unexpected deaths have to be reported; examples in the new guidelines suggest that only events that result in death need to be reported (rather than events that “contribute to” death).
• Stealing and financial coercion: requirements for reporting systems are now less prescriptive; missing valuables now only have to be reported to the Commission if the consumer “believes that a staff member is responsible and appears concerned or distressed about the loss”.
• Neglect: the new guidelines acknowledge that there may be minor incidents of neglect that do not need to be reported.
• Commission’s function of “supporting” providers has changed to “providing guidance” to providers.
• Powers of the Commission: new guidelines state that Commission may “take any reasonable action” in response to an incident; Commission may use SIRS data for other purposes.
• Attachment A: SIRS notification form questions: “impact” now includes “not only actual harm, but also harm that could reasonably have been expected to have been caused”.

Clarification of Priority 2 obligations and commencement dates

The new guidelines state that: “From 1 April 2021 providers are required to have in place an effective incident management system and report to the Commission all reportable incidents assessed as Priority 1 reportable incidents. From 1 October 2021 providers are required to report all reportable incidents whether they are assessed as Priority 1 or Priority 2.”

New definition of “Priority 2 reportable incident”

Duty of care – narrower, more precise definition

Unreasonable use of force – “allegations of force” deleted from list of examples of unreasonable use of force

Note: page 3 of the new guidelines says that the Commission has provided an “Additional example of ‘rough handling’ in the section detailing unreasonable use of force.” However, no such update appears to have been made to that section.

Sexual contact or inappropriate sexual conduct – example amended to broaden possible inappropriate contact

One of the examples has been amended to make it clear that in some cases, “rubbing a consumer’s back or patting a consumer on the knee” will constitute unlawful contact.

Unexpected death: not all unexpected deaths have to be reported

The new guidelines provide “clarification that the term unexpected death refers to circumstances where the death could reasonably be considered to be related to a mistake, failure or incident. Previous guidance noted that all unexpected deaths need to be notified to the Commission, this has been updated to refer to unexpected deaths that meet the criteria in Subsection 15NA(8) of the Quality of Care Principles. Removal of examples that were not consistent with these criteria.”

Unexpected deaths: broad examples have been narrowed

The language used in the examples of unexpected death has been changed so that unexpected death now has a narrower, more precise definition. In the old version, if certain events “contributed to or resulted in the consumer’s death” this would qualify as “unexpected death”. In the new version, the term “contributed to” has been removed. Also, some examples have been deleted from the new version.

Stealing and Financial coercion – requirements of your reporting system are now less prescriptive

Stealing and Financial coercion – narrower definition of reportable incidents involving missing valuables

The new guidelines suggest that missing valuables only have to be reported to the Commission if the consumer “believes that a staff member is responsible and appears concerned or distressed about the loss.”

Neglect – example amended to include “failure to administer correct medications”

Neglect – “failing to appropriately dress consumer for weather conditions” deleted from examples

Neglect – acknowledgement that there may be minor incidents of neglect that do not need to be reported

Restraint – “physical restraint used in non-emergency situations” removed from list of examples of restraint that must be reported

Restraint – if chemical restraint is used you must document the reason it was necessary

Reporting to police – meaning of “reasonable grounds” clarified

You must report an incident to police when you have “reasonable grounds” to do so. The new guidelines have not changed this requirement, but they have added this statement to clarify when you must report to police:

“In practice:

• if you become aware of a reportable incident
• that reportable incident is criminal in nature

 the grounds for reporting to police are reasonable in the circumstances reporting must occur. Reporting to the police in relation to criminal conduct should occur regardless of whether the incident is alleged or suspected to have occur.”

Notification – time limit is counted in “calendar days” not “work days”

The new guidelines clarify that reporting deadlines are in calendar days not working days: five calendar days to notify the Commission of additional information (if required); 30 calendar days to notify a Priority 2 incident (from 1 October 2021).

Notification – new example of “significant new information”

If you become aware of significant new information in relation to an incident after you have reported it, you must notify the Commission as soon as possible. This requirement has not changed. However, the new guidelines clarify the meaning of “significant new information” with this example:

An example is where a consumer has had a fall due to a failure by care staff to follow standard procedures. The provider has submitted a SIRS notice as the incident is a reportable incident which details that the consumer has been hospitalised and is palliative. If the consumer dies, this is considered significant new information and must be notified to the Commission.

Role, Powers and Processes of the Commission – Commission’s response procedure clarified

Role, Powers and Processes of the Commission – Commission’s function of “supporting” providers changed to “providing guidance”

Role, Powers and Processes of the Commission – Commission’s procedure for “assessment of a reportable incident” clarified

Under “Assessment of a reportable incident” (p. 69), the new guidelines include this new explanation of what the Commission does when it receives a notification:

When the Commission receives a notification of a reportable incident, it will review the notice to assess the risk to consumers, the adequacy of the actions being taken by the provider to manage and mitigate any such risk and any other factors that may influence the Commission’s confidence in the provider’s ability to manage the risk and reduce the likelihood of recurrence.

Role, Powers and Processes of the Commission – new statement of broad powers to respond, investigate and use information

Commission can take any reasonable action

The new guidelines add this power to the list of what the Commission can do when responding to an incident: “take any other action to deal with the reportable incident that the Commissioner considers reasonable.”

Commission can use SIRS data for other purposes such as performance assessments

Under “Review of reportable incident notice complete” (p. 59), the new guidelines say:

The Commission may also use the information provided in the SIRS notice and any further information obtained by the Commission as part of its ongoing regulatory functions under the Aged Care Quality and Safety Commission Act 2018. Information notified through the SIRS also informs the Commission’s risk profiling of providers and the prioritisation and scope of monitoring and performance assessment activities.

And:

Where an investigation is required, this may include a visit to the site by authorised officers of the Commission. Authorised officers may exercise monitoring powers to determine whether a provider is complying with its incident management responsibilities.

The Commission’s monitoring powers can be utilised regardless of whether or not there has been non-compliance, and may support, precede or follow other actions.

Miscellaneous Changes in terminology

Attachment A: SIRS notification form questions – “impact” now includes “not only actual harm, but also harm that could reasonably have been expected to have been caused”

The new guidelines add the following words (shown in bold) to the instructions regarding “victim details” and “alleged offender details”:

• “Select the appropriate level of psychological impact (provide further details if some level of impact is selected including not only actual harm, but also harm that could reasonably have been expected to have been caused).”
• “Select the appropriate level of physical impact (provide further details if some level of impact is selected including not only actual harm, but also harm that could reasonably have been expected to have been caused).”