Extension of SIRS to home care

From 1 December 2022, the Serious Incident Response Scheme (SIRS) will be extended to home care and flexible care delivered in a home or community setting.

Are you a home care provider preparing to implement the SIRS in your service? Read on to understand how these new obligations will apply to you.

What is the SIRS?

We have previously discussed the SIRS in an earlier blog post. The SIRS was introduced in the residential aged care setting on 1 April 2021, and was developed to ensure incidents of abuse and neglect of older people in residential care are appropriately dealt with and prevented. To learn more about the SIRS, click here to read our blog post from 2021.

New legislation has been introduced to extend the operation of the SIRS to home care and flexible care delivered in a home or community setting. This includes providers of Home Care Packages, CHSP services and flexible care services through which short-term restorative care is provided in a home care setting. 

The concept of the SIRS remains largely similar, however there are some key differences in how the scheme will operate in the home care context.

The legislation is currently in draft form, so please note that the following advice is subject to change.

What is required of providers?

From 1 December 2022, providers of home and flexible care must have an incident management system in place, and inform the Aged Care Quality and Safety Commission (the Commission) if a reportable incident occurs.

What is a reportable incident?

A reportable incident is:

  • an incident that has occurred, or is alleged or suspected of having occurred, in connection with the provision of care to a consumer;
  • the incident has caused harm, or could reasonably have been expected to have caused harm, to a consumer; and
  • the incident is one of the following types of incidents:
    • unreasonable use of force
    • unlawful sexual contact or inappropriate sexual conduct
    • psychological or emotional abuse
    • unexpected death
    • stealing or financial coercion
    • neglect
    • inappropriate use of restrictive practices, or
    • missing consumers.

For home services, this may include any incidents:

  • resulting from the action (or inaction) of a staff member of the provider (including subcontracted individuals or organisations, those managing care coordination, administration, etc. and volunteers),
  • that occur while care and services are being delivered to a consumer.

Classifying incidents (Priority 1 vs Priority 2)

All actual, suspected or alleged reportable incidents must be reported to the Commission. Incidents will fall into categories: Priority 1, or Priority 2.

Priority 1

A Priority 1 reportable incident is a reportable incident:

  • that caused, or could reasonably have been expected to have caused, a consumer physical or psychological injury or discomfort that requires medical or psychological treatment to resolve
  • where there are reasonable grounds to report the incident to police
  • involving unlawful sexual contact or inappropriate sexual conduct inflicted on a consumer
  • that is an unexpected death of a consumer, or
  • where a consumer goes missing in the course of provision of home services.

If you become aware of a reportable incident and have reasonable grounds to believe it is Priority 1 reportable incident, you must notify the Commission within 24 hours of becoming aware of the incident.

Priority 2

A Priority 2 reportable incident is any reportable incident that does not meet the Priority 1 criteria as described above.

All Priority 2 reportable incidents must be notified to the Commission within 30 calendar days of becoming aware of the reportable incident.

So, how does SIRS in the home care/flexible care setting differ from the residential setting?

As mentioned, many of the SIRS requirements for home/flexible care are consistent with the existing SIRS regime that applies to residential care. However, there a couple of key differences in the new application of SIRS for home care that you should note.

Additional reportable incident: missing consumer

The new legislation includes an additional type of reportable incident, to cover occurrences where:

  • a care recipient goes missing in the course of a provider providing home care, or flexible care provided in a community setting, to the care recipient; and
  • there are reasonable grounds to report that fact to the police.

The phrase ‘in the course of providing … care’ is significant; this definition is intended to capture situations where a provider has the consumer in their physical care immediately prior to the consumer going missing.

This definition is not intended to require providers to report to the Commission where a staff member arrives for a scheduled visit and the consumer is not present, or where a consumer leaves their home while home maintenance services are being provided, as an example.

Different definition of unexpected death for home care

The circumstances in which home care providers are required to report unexpected deaths are more limited than in residential care.

Home care providers will be required to notify any death where the provider (including staff and health professionals engaged by the provider):

  • made a mistake resulting in death; or
  • did not deliver care and services in line with a consumer’s assessed care needs, resulting in death; or
  • provided care and services that were poorly managed or not in line with best practice, resulting in death.

This definition differs from the definition used in residential care. This difference acknowledges that home care providers have limited control and visibility over a consumer’s day-to-day living circumstances when compared to residential care settings. Home care providers may not become aware of a consumer dying until some time after the death occurs and may never be aware of the circumstances of their death.

Providers are not required to notify the Commission of the death if the cause of death was unrelated to the care or services provided by the provider or a failure by the provider to provide care and services.

Different definition of inappropriate use of restrictive practice for home care

The new legislation states that the use of a restrictive practice in the course of providing home care or flexible care in a community setting is not a reportable incident if:

  • the restrictive practice is used in the course of providing home care or flexible care in a community setting; and
  • before the restrictive practice is used, the following matters were set out in the care and services plan for the care recipient:
    • the circumstances in which the restrictive practice may be used in relation to the recipient, including the recipient’s behaviours of concern that are relevant to the need for the use;
    • the manner in which the restrictive practice is to be used, including its duration, frequency and intended outcome; and
  • the restrictive practice is used:
    • in the circumstances set out in the plan; and
    • in the manner set out in the plan; and
    • in accordance with any other provisions of the plan that relate to the use; and
  • details about the use of the restrictive practice are documented as soon as practicable after the restrictive practice is used.

This differs from the rules for residential care, where use of restrictive practices must be documented in a behaviour support plan.

The residential care environment is different to the operating environment of home care or flexible care provided in home or community settings, where care recipients generally have greater autonomy and less complex requirements. In the home care setting, a behaviour support plan may not be required.

However, providers of home care and flexible care delivered in a home or community setting must still implement a care and services plan for each care recipient that satisfies the requirements set out in the Aged Care Quality Standards.

Exception: incidents of neglect in the home care setting which are not a reportable incident

Despite neglect being a reportable incident under the Aged Care Act, the new legislation provides for circumstances in which certain incidents in the home/flexible care setting are not reportable incidents under the SIRS. An incident is not a reportable incident if:

  • the incident occurred, is alleged to have occurred, or is suspected of having occurred, in connection with the provision of home care, or flexible care provided in a community setting, to a care recipient; and
  • the incident results from a choice made by the care recipient about the care or services the provider is to provide to the care recipient, or how the care or services are to be provided by the provider; and
  • before the incident occurred, is alleged to have occurred, or is suspected of having occurred, the choice had been communicated by the care recipient to the provider, and the provider had recorded the choice in writing.

This amendment reflects feedback received by the Commission that home care/flexible care recipients should be able to maintain choice and autonomy over their living situation. The home care or flexible care provider must have recorded the choice that the care recipient communicated to them in writing before the incident occurred, and must also be satisfied that the care recipient has the capacity to make this decision.

Summing up

We hope our overview has helped you get up to speed on these new home care requirements.

We recommend providers take a look at the full draft Serious Incident Response Scheme Guidelines for providers of home services for more thorough guidance on the Scheme.

 

Do you need help with incident management?

Get ready for the revised Aged Care Quality Standards

Reforms to the aged care sector continue, with the recent release of a consultation draft of the revised Aged Care Quality Standards (‘Quality Standards’). The new Quality Standards have some key differences compared to the existing standards – they are significantly more detailed, and represent a move away from the higher-level approach of the existing standards. There is definitely a lot for providers to take in, so let us help you get up to speed with our overview of the key changes.

Why are the Quality Standards changing?

The Royal Commission into Aged Care Quality and Safety found that the existing Quality Standards are not sufficiently ‘comprehensive, rigorous and detailed’.

The Royal Commission identified specific areas of improvement for the Quality Standards, including the need to:

  • reflect the needs of people with dementia;
  • better recognise diversity and improve cultural safety for Aboriginal and Torres Strait Islander people;
  • strengthen requirements in relation to governance and human resources;
  • describe more detailed requirements relating to food and nutrition; and
  • improve clinical care.

The revisions to the Quality Standards were also informed by engagement with the sector, an independent review, and comparison with existing standards for health care and disability support – the National Safety and Quality Health Service (NSQHS) Standards, and the NDIS Practice Standards.

What will the new Quality Standards look like?

Standard 1: The Person

Standard 1 focuses on important concepts including dignity and respect, older person individuality and diversity, independence, and culturally safe care.

The new Standard 1 remains fairly similar to existing Standard 1: Consumer dignity and choice in the current Quality Standards, with a focus on the older person.

Outcomes

  • Person-centred care
  • Dignity, respect and privacy
  • Choice, independence and quality of life
  • Transparency and agreements

Standard 2: The Organisation

Standard 2 is intended to hold the governing body responsible for fulfilling the requirements of the Quality Standards and delivering safe and quality care. Standard 2 goes into more detail than the current standards by itemising more requirements for systems that providers should have in place (including requirements regarding partnering with older people, accountability and quality systems, workforce planning, and emergency and disaster management).

Outcomes

  • Partnering with older people
  • Quality and safety culture
  • Accountability and quality systems
  • Risk management
  • Incident management
  • Feedback and complaints management
  • Information management
  • Workforce planning
  • Human resource management
  • Emergency and disaster management

Standard 3: The Care and Services

Standard 3 describes the way providers must deliver care and services. It sets out more detailed requirements regarding how providers assess each older person’s needs, goals and preferences, document this in a care plan and use this to inform the way care is delivered. Standard 3 includes a new requirement that providers implement a system for caring for people living with dementia.

Outcomes

  • Assessment and planning
  • Delivery of care and services
  • Communicating for safety and quality
  • Coordination of care and services

Standard 4: The Environment

Standard 4 focuses on the physical environment, which must be clean, safe and comfortable and enable freedom of movement for older people. Standard 4 also sets out requirements regarding infection prevention and control systems.

Outcomes

  • Environment and equipment at home
  • Environment and equipment in a service environment
  • Infection prevention and control

Standard 5: Clinical Care

Standard 5 describes the responsibilities of providers, with respect to the delivery of clinical care. Standard 5 articulates more detailed and technical requirements for clinical care compared with the existing standards, including in areas such as technical nursing, advance care planning, continence, falls and mental health. This standard was developed by the Australian Commission on Safety and Quality in Health Care, and aligns with the NSQHS Standards.

This standard will apply to providers delivering clinical care, whether it is in an older person’s home or a residential environment.

Outcomes

  • Clinical governance
  • Preventing and managing infections in clinical care
  • Medication safety
  • Comprehensive care
  • Care at the end life

Standard 6: Food and Nutrition

Standard 6 sets out requirements regarding what older people can expect of the food and drink they are provided in residential care services. It includes the requirement that food and drink is appetising, nutritious and safe, and that the dining experience is enjoyable. Having a dedicated standard for food and drink is a new development, and represents a greater focus on this area.

Standard 6 will apply only to residential care services.

Outcomes

  • Partnering with older people on food and nutrition
  • Assessment of nutritional needs and preferences
  • Provision of food and drink
  • Dining experience

Standard 7: The Residential Community

Standard 7 is about the residential community, and focuses on continuity of care, security of accommodation, and strategies to help older people maintain relationships.

Standard 7 will apply only to residential care services.

Outcomes

  • Daily living
  • Planned transitions

Other noteworthy changes

  • Use of the phrase ‘older person’/’older people’ – The term currently used to refer to a person receiving services under the existing Quality Standards is ‘consumer’, however the Aged Care Quality and Safety Commission acknowledges that this term is not generally well-received by older people. The new term used throughout the revised Quality Standards is ‘older person’.
  • More requirements, that are more detailed – The current Quality Standards are outcomes-focused and consist of eight standards, which include a consumer outcome, an organisation statement and a number of requirements. The new Quality Standards describe more detailed expectations for providers, with an increase from 42 requirements to 31 outcomes with 142 supporting actions. This may look like an increase in the regulatory burden for providers, but the intention is to provide greater clarity to providers, by being more specific about how to achieve the outcomes laid out in the Quality Standards.

Similarities with NDIS Practice Standards

The updated Quality Standards will align structurally with the NDIS Practice Standards, by following a ‘modular’ format and using outcomes and actions (called ‘quality indicators’ in the Quality Standards). The two sets of standards don’t have identical content, but there are plenty of similar themes, and the same pieces of evidence may be used by a provider to satisfy outcomes across both sets of standards. For example, an organisation’s incident management policy may be used to demonstrate compliance with the incident management outcome across both sets of standards.

Government is also considering regulating providers through a registration model, similar to the NDIS Practice Standards. Employing a registration model means that, “requirements for market entry and ongoing provider responsibilities would be applied proportionately, based on the provider’s registration category. A provider’s registration category would be determined based on the types of care and services the provider is seeking to deliver and the risks associated with them”. This is similar to how the NDIS Practice Standards currently operate.

What does the rollout look like?

There will be some time before the new Quality Standards are up and running.

Currently, the Department of Health Aged Care is holding a public consultation process for the Quality Standards, and providers are invited to take part.

Following the public consultation, Aged Care Quality and Safety Commission will conduct a pilot of the new Quality Standards, to test an updated audit methodology for the Standards.

Providers can expect guidance materials and further updates on the revised Quality Standards in early 2023.

Looking for more information?

The Commission has released a number of helpful resources for the new Quality Standards, including both a summary as well as a detailed Consultation Paper, and a summary and detailed document setting out the new Quality Standards themselves.

To understand the intention behind the new Quality Standards, as well as what all of the requirements are, you might like to take a look at the Commission’s Summary Consultation Paper, as well as the Summary draft of the Quality Standards.

Do you need assistance meeting the Aged Care Quality Standards?