Reportable Incidents and Cognitive Impairments
You may have noticed that our last few blog posts (here and here) have been focused on reportable incidents relating to aged care environments; remembering that aged care reportable incidents pertain to physical assault or unreasonable use of force, sexual assault and unexplained absences. Up until this point we have been talking at length about these incidents being committed by a care worker or family member, but it is important to note that within an aged care facility, incidents of assault can occur between residents.
So, what happens if a resident is suspected of, or found to have assaulted another resident?
It would be easy to assume here that a care worker or family member should follow the same reporting protocols outlined in our previous blog posts. But as with all theoretical scenarios, the ‘real life’ procedures are not so clear cut. To explain why, let’s re-phrase the previous question:
What happens if a resident with dementia is suspected of, or found to have assaulted another resident in a dementia unit?
In this scenario, staff or family members often incorrectly assume that because both residents reside in a dementia unit, they have a cognitive impairment, and therefore the incidents are not reportable to the Department of Health. Here, cognitive impairment refers to declining ability in judgement, memory, learning, comprehension, reasoning and/or problem solving and can result from a number of conditions, including dementia, delirium and/or depression.
In this instance, the provider has to meet strict conditions in order to actually bypass their requirement to report. These are detailed in the Accountability Principles, 2014, and state that:
- Within 24 hours of receiving an allegation or becoming suspicious, the provider forms an opinion that the assault was committed by a resident, and
- Prior to the receipt of the allegation, the resident has been assessed by an appropriate health professional as suffering from a cognitive or mental impairment, and
- The provider puts in place arrangements for management of the resident’s behaviour within 24 hours of the allegation or suspicion, and
- The provider has a copy of the assessment (or other documents) regarding the resident’s cognitive or mental impairment, and
- The provider has a record of the behaviour management strategies that have been put in place.
Put simply, the provider has an obligation to report all reportable incidents, except where each and every one of the five conditions above has been met. To meet these requirements, an assessment of a resident’s cognitive impairment must be undertaken by a resident’s medical practitioner orgeriatrician or a registered nurse (RN) or another medical practitioner with the appropriate clinical expertise, in a community or hospital setting.
The takeaway point here is that it is not up to care workers or family members to decide not to report because the resident seems to have a cognitive impairment. There are strict conditions a provider must meet in order to not report an incident. It is important to remember that a provider only has 24 hours to report the incident, which begins the moment they become aware of the incident. Failure to meet this deadline can and will result in sanctions being placed on the provider, which can have a trickle-down effect on resident intake and staff employment.
So, when in doubt, always report the incident to your appropriate line manager (or staff if you are a family member), and management will decide whether the incident needs to be reported to the Department.
