Unreasonable use of force tops SIRS reporting

Many instances of unreasonable use of force in aged care homes are avoidable and greater efforts must be made to identify risks to residents, says report.

Many instances of unreasonable use of force in aged care homes are avoidable and greater efforts must be made by providers to identify risks to residents, says a new report.

Published by the Aged Care Quality and Safety Commission, the report shows nearly two-thirds of cases recorded during the first 15 months of the Serious Incident Response Scheme – 1 April to 30 June 2022 – concerned unreasonable use of force (62 per cent).

Source: SIRS Insights Series: Report 1 – 2023
Janet Anderson

“In many cases where a serious incident is reported, the aged care provider has already dealt very effectively with the incident – taking all necessary steps to address any issues for the person concerned and making the changes required to prevent these incidents from happening again,” said Aged Care Quality and Safety Commissioner Janet Anderson in a statement.

“However,” added Ms Anderson, “there are aspects of managing incidents where some providers still need to improve at an operational and governance level.”

SIRS was established in April 2021 to help providers reduce and prevent incidents such as unreasonable use of force occurring in residential aged care (the scheme has since been extended to include home care and flexible care).

“Information we receive from SIRS notifications shines a light on the incidents that are occurring in aged care services and, importantly, the actions that providers need to take to mitigate the risks that come with caring for frail older people,” said Ms Anderson.

Source: SIRS Insights Series: Report 1 – 2023

While nearly one in 10 incidents of unreasonable use of force involved staff, 86 per cent involved interactions between residents, and it’s these cases that the report focuses on.

Source: SIRS Insights Series: Report 1 – 2023

According to the commission, providers report severe cognitive impairment in more than half of those affected residents.

Recognising that dealing with residents who are severely cognitively impaired is challenging for providers, the report says “such incidents should not be considered unavoidable.”

The high proportion of notifications of unreasonable use of force, compared with other incidents, says the report, can partly be attributable to the broad range of incidents that are captured under the heading – including squeezing, grabbing, pinching, hitting, pushing, rough handling and forcing someone to move against their will.

However, as the report’s authors note, there are ways to reduce such incidents from occurring.

They include:

  • an effective incident management system that includes preventative action
  • recognising impact – which is fundamental to responding to an incident appropriately
  • improving behaviour support planning and behaviour management
  • improving governance, including board scrutiny and responses when incidents occur
  • supporting staff to recognise and act early in situations which could otherwise escalate.
Dr Melanie Wroth

“Staff who see things going wrong and who have clear processes to take action and/or escalate a response at their service can make a dramatic difference,” said chief clinical advisor Dr Melanie Wroth in the same statement. “Every person working to care for older people, at whatever level, has the potential to make a difference.”

Gleaning insights from case studies, the report’s authors recognise that staff may not always identify issues that have been building up over time until a resident becomes frustrated and lashes out.

Other takeaways include:

  • staff must be helped to understand a resident’s behaviour in the context of the setting, the resident’s underlying conditions and how they might be feeling
  • blame and punishment of residents must be avoided
  • assessment of impact should not be confined to immediate physical harms
  • many incidents are provoked, which is key to understanding and prevention
  • the person using force often also needs support as their needs may have been dismissed or neglected
  • many incidents are recurrent, with the same individuals involved.

“This raises questions about whether the provider has an effective incident management system that they are using to identify and address such undesirable patterns,” said Ms Anderson. “In these situations the commission may undertake a targeted investigation that could lead to regulatory actions.”

The unreasonable use of force report is the first of a series of publications due to be released by the commission. Over time, the series will explore all eight reportable incident types under SIRS in residential care.

The report series aims to help providers improve how they respond to reduce serious incidents in their facilities. “We know we need to be realistic about how quickly it will happen,” said Ms Anderson, “but we definitely want to see improvements in care and in the prevention of incidents, with the rate of incidents reducing over time.”

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Tags: aged care quality and safety commission, dr melanie wroth, featured, Janet Anderson, SIRS, unreasonable use of force,

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