Aged care providers are significantly underassessing the impact of unexplained absences of residents, according to a regulatory report.
Published by the Aged Care Quality and Safety Commission, the report – Unexplained absence from care – finds that, in the 12 months to March 2023, providers recorded that 91 per cent of unexplained absences had no-to-minimal physical impact and 95 per cent had no-to-minimal psychological impact.
“Our review of notifications shows this is a significant underassessment,” writes commission chief Janet Anderson. “Recognising impact is vital to managing incidents appropriately and ensuring that anyone affected by an incident receives the care and support they need.”
“Reassuringly,” adds Ms Anderson, “[unexplained absences] is one of the lowest reported incident types, accounting for just over 1,700 SIRS notifications to the commission.”
SIRS data between 1 April 2022 and 31 March 2023 found that 22 per cent of absent residents were found at the aged care facility, a private home or at a hospital. “A worrying”, 77 per cent of missing residents were found in a location listed as “other”, which suggests they were not safely supervised during their absence.
According to the report, residents are most likely to leave a facility within the first month or so of entering the aged care home. “Providers should be aware of the risks when residents are new to the service,” say the report’s authors, “and may have entered residential care unwillingly or unhappily.”
The commission’s report also highlights missed opportunities for prevention of absences. “We have found that residents involved in an unexplained absence incident have often tried to leave the service multiple times before,” writes Ms Anderson.
Recognising the warning signs and anticipating an incident “is vital in preventing risk to all aged care residents. How a provider responds to an incident when it does happen is central to making sure other residents are not involved in similar incidents.”
Unexplained absences are a priority one SIRS notification, which means that all such incidents must be reported to the commission within 24 hours. However, some providers are incorrectly reporting unexplained absences as a priority two notification, which need to be lodged within 30 days.
The commission calls on providers to strengthen how they oversee their legislative compliance, manage and use restrictive practices, and develop behaviour support plans. There is also a need for individual care plans that consider both a person’s risk of harm and right to freedom of movement.
In some cases, suggests the commission, providers may consider using monitoring and location devices to enable residents to access the community more safely and maintain independence.
The commission’s report is the second in a series of documents exploring data received through SIRS – the first focused on unreasonable use of force.
SIRS was established in April 2021 to help providers reduce and prevent incidents such as unexplained absences occurring in residential aged care. The scheme has since been extended to include home care service providers, whose notifications will be the subject of future reports.
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There is great potential to address the challenge of ‘unexplained absence’ through geo-tracking technologies. In my opinion the ethics and acceptability of visible wearables, such as wristbands, that continuously track older people in residential care, is questionable. However more discreet devices can be worn *with consent*, especially by new residents, or residents undertaking respite, who are more likely to leave unexpectedly, and can be activated only if the resident is unexplainedly offsite and needs to be located. Automatic creation of a report for SIRS requirements could be built into the system.