What is the Serious Incident Response Scheme (SIRS)?

All residential aged care consumers have the right to receive safe and high-quality care.

In April 2021, a new federal government initiative known as the Serious Incident Response Scheme (SIRS) will commence, aiming to reduce the risk of abuse and neglect in Commonwealth funded residential aged care (Aged Care Quality and Safety Commission 2020).

The SIRS expands upon the protections to older adults in residential aged care currently offered by the Aged Care Act 1997.

What are the Current Requirements?

Under the Aged Care Act 1997, residential aged care providers are required to report alleged, suspected or actual reportable assaults to the police and Department of Health. This must be done within 24 hours of either an allegation or reasonable suspicion that a reportable assault has occurred (Department of Health 2019). ‘Reportable assaults’ include:

• Unlawful sexual contact (any non-consensual sexual contact, including cases where a consumer cannot give informed consent due to cognitive or mental impairment); and
• Unreasonable use of force (unwarranted physical contact, even if it does not cause visible harm).

(Ma 2020)

Notably, neglect, inappropriate physical and chemical restraint, intentional and reckless staff behaviour, and poor personal care are not listed as types of reportable assault under the Act (Ma 2020).

Furthermore, there are two situations in which residential aged care providers are not required to report a reportable assault, these being:

• If the perpetrator is a consumer who has been assessed to have a cognitive or mental impairment, and arrangements can be made to manage their behaviour within 24 hours or
• The same (or essentially the same) incident has already been reported to the police and Department of Health.

(DoH 2019; Ma 2020)

Due to these exemptions, along with the narrow definition of ‘reportable assault’, there is concern that potentially-serious incidents are ‘falling through the gaps’, with the exact nature and frequency of these events unknown. Therefore, current legislation may not offer enough protection for older adults in residential aged care (DoH 2019; Ma 2020).

What is the Serious Incident Response Scheme (SIRS)?

The SIRS was established based on recommendations from the Australian Law Reform Commission (ALRC). The ALRC proposed that reportable incidents should be expanded to include situations that are not specified in the Aged Care Act 1997 and that greater emphasis should be placed on investigating and responding to incidents rather than simply reporting their occurrence (DoH 2019).

Under the SIRS, Commonwealth funded residential aged care providers will be required to

• identify,
• record,
• manage and
• resolve

all serious incidents, as well as take appropriate steps to prevent similar incidents from occurring again in the future. The SIRS also requires providers to put into practice an incident management system (DoH 2020).

The SIRS aims to ensure that service providers deliver safe and effective care, and that consumers are adequately supported if an incident does occur. Through the implementation of an effective incident management system, providers should be able to respond to incidents more appropriately, provide consumers with access to support and continuously improve their services (ACQSC 2020; DoH 2019).

The SIRS will sit alongside the Aged Care Quality Standards, Charter of Aged Care Rights and Open Disclosure Framework and Guidance to ensure that service providers are held responsible for managing incidents that occur in their facilities (DoH 2020).

Incident Management Systems

Underpinning the SIRS is the importance of establishing an effective incident management system. This system should comprise processes and procedures for:

• Identifying, assessing, recording, managing and resolving incidents;
• Taking appropriate action in response to incidents (e.g. removing consumers from harm, documenting, reporting);
• Reporting incidents to the Aged Care Quality and Safety Commission;
• Reporting incidents to the police if necessary;
• Notifying consumers’ families and decision-makers if necessary;
• Supporting consumers who have been affected by incidents to ensure their health, safety and wellbeing (including those whom allegations have been made against);
• Involving consumers and other relevant parties in the management and resolution of incidents (in accordance with open disclosure principles);
• Investigating incidents or participating in external investigations;
• Taking and monitoring corrective actions; and
• Using incident data to facilitate continuous improvement and prevent similar incidents from occurring again in the future.

(ACQSC 2020; DoH 2020b)

It is your responsibility to read and fully understand your facility’s incident management systems and SIRS policies and procedures.

What are Serious Incidents Reportable Under the SIRS?

The SIRS defines a serious, reportable incident as incidents that have either

• Actually occurred
• Are alleged to have occurred, or
• Are suspected of having occurred.

(ACQSC 2021)

The incident also must have affected a consumer and was perpetrated by either a

• Staff member
• Family, friend or other visitor, or
• Another consumer (even if that consumer has a cognitive or mental impairment.)

(DoH 2020a, b; ACQSC 2021)

And the incident must have occurred in connection with the provision of residential care (or flexible care provided in a residential setting) (ACQSC 2021).

Any allegation, suspicion or witness account of the following will be required to be reported to the Aged Care Quality and Safety Commission:

(ACQSC 2020; DoH 2020b)

Exemptions

Providers are not required to report an incident if:

• The event is assessed not to be a serious incident, as the consumer was being reasonably cared for or managed in line with relevant codes of conduct and professional standards (e.g. a consumer stepping on the road into traffic and being grabbed by a staff member to remove them from harm); or
• The incident relates to or is essentially the same as a previous incident that was reported under the SIRS (same date, time, people involved etc.)

(DoH 2020b)

Categorising Incidents

Under the SIRS, the period of time within which to notify a reportable incident to the Commission will depend on how the incident is categorised by your organisation.

• Priority 1 reportable incident or
• Priority 2 reportable incident.

Priority 1 Reportable Incidents

Starting from the 1st of April 2021, providers are required to notify the Commision of Priority 1 incidents within 24 hours.

Priority 1 incidents are assessed as a reportable incident:

• ‘That causes, 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, or
• Where there are reasonable grounds to report the incident to police, or
• That is a consumer’s unexpected death or a consumer’s unexplained absence from the service.’

(ACQSC 2021)

Priority 2 Reportable Incidents

Starting from the 1st of October 2021, providers will also be required to notify the Commission of Priority 2 incidents within 30 days.

The Commission describes Priority 2 incidents as a reportable incident that ‘results in a low level of harm to a consumer … where the consumer is momentarily shaken or upset … [or] where medical or psychological treatment for the consumer is nor required’ (ACQSC 2021).

Additionally, in cases where the category is difficult to determine, SIRS guidance suggests that the incident should be treated as Priority 1.

Notifying the Commission

The SIRS requires a formal notification be lodged with the Aged Care Quality and Safety Commission digitally via the My Aged Care service provider portal. Depending on your organisation’s SIRS policy and incident management system, the person responsible for filing this form may change from provider to provider, however, all staff have a duty to recognise and report serious incidents as soon as they become aware of them.

A sample SIRS notification form is available at: https://www.agedcarequality.gov.au/...SIRS_Guidance_Final.pdf

SIRS guidance states that providers should encourage a culture of accountability and that staff feel confident reporting incidents to the appropriate person.

Raising concerns about a serious incident directly with management is encouraged, however, any staff member is also able to raise a concern directly to the Commission.

Reportable Incidents Involving NDIS Participants

If a reportable incident causes harm to a participant of the National Disability Insurance Scheme (NDIS) or occurs during the provision of support or services by an NDIS provider, the provider is required to notify the Commission (ACQSC 2021).

If a consumer who is both a residential aged care recipient and an NDIS participant is involved in a reportable incident under the SIRS, both the Aged Care Quality and Safety Commission and the NDIS Quality and Safeguards Commission must be notified (ACQSC 2021).

Note that the definition of a reportable incident, as well as required reporting timeframes and required information to be reported may differ between the SIRS and then NDIS. More information about the NDIS requirements can be found in Reportable incidents: Detailed Guidance for Registered NDIS Providers (ACQSC 2021).

Protections

There are also a number of ‘whistleblower’ protections afforded to those who report serious incidents under the Aged Care Act, that have been expanded with SIRS. These include:

• Protection from civil or criminal liability
• Qualified privilege in any defamation proceedings that arise
• Protection from liability to an action for defamation
• Protection from having a remedy (contractual or other) enforced against them
• Compensation for any detriments (actual or threatened) suffered due to disclosure.

(ACQSC 2021)

However, in order to be protected under SIRS, the following conditions must be met:

• The staff member discloses the incident to either: the provider, one of the provider’s key personnel, a staff member of the approved provider, a person who has been designated by the approved provider to receive incident reports, a police officer or the Aged Care Commission on Safety and Quality in Health Care.
• The staff member provides their name before making the disclosure.
• The person who has been disclosed to has ‘reasonable grounds’ to believe that a reportable incident has occured.
• The disclosure is made in good faith, i.e. the information is relayed truthfully along with any relevant context and qualifications, and there is no prejudice or malicious intent motivating the disclosure.

(ACQSC 2021)

If someone makes a report to you, it is your responsibility to protect the discloser’s identity (except from key personnel, the Commission or the police, or if revealing their identity is required by law).

For more information on the Serious Incident Response Scheme and any of the information mentioned in this article, visit: https://www.agedcarequality.gov.au/...SIRS_Guidance_Final.pdf.

Additional Resources

• Serious Incident Response Scheme: Guidelines for Residential Aged Care Providers | ACQSC
• The Aged Care Quality Standards | ACQSC
• Charter of Aged Care Rights | ACQSC
• Open Disclosure Framework and Guidance | ACQSC
• Reportable incidents: Detailed Guidance for Registered NDIS Providers | NDIS
• Serious Incident Response Scheme (SIRS) | Ausmed Course

References

• Aged Care Quality and Safety Commission 2020, Serious Incident Response Scheme, ACQSC, viewed 11 January 2021, https://www.agedcarequality.gov.au/consumers/serious-incident-response-scheme
• Aged Care Quality and Safety Commission 2021, Serious Incident Response Scheme: Guideline for Residential Aged Care Providers, ACQSC, viewed 12 March 2021, https://www.agedcarequality.gov.au/sites/default/files/media/SIRS_Guidance_Final.pdf
• Australian Department of Health 2019, Serious Incident Response Scheme for Commonwealth-funded Residential Aged Care, DoH, viewed 11 January 2021, https://agedcare.royalcommission.gov.au/system/files/2020-06/RCD.9999.0174.0021.pdf
• Australian Department of Health 2020b, Serious Incident Response Scheme for Commonwealth-funded Residential Aged Care - Model for Implementation, DoH, viewed 12 January 2021, https://www.health.gov.au/sites/default/files/documents/2020/10/serious-incident-response-scheme-for-commonwealth-funded-residential-aged-care-model-for-implementation_0.pdf
• Australian Department of Health 2020a, Serious Incident Response Scheme (SIRS), DoH, viewed 11 January 2021, https://www.health.gov.au/initiatives-and-programs/serious-incident-response-scheme-sirs
• Ma, J 2020, ‘New Serious Incident Response Scheme: What we Know so Far About Aged Care Providers’ Obligations’, Aged Care Essentials, 30 June, viewed 11 January 2021, https://www.agedcareessentials.com.au/news/new-serious-incident-response-scheme-what-we-know-so-far-about-aged-care-providers-obligations