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Neglect

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What is neglect?

Neglect is:

  • a breach of duty of care to a consumer by a provider or worker
  • a gross breach of professional standards in providing care or services to a consumer. 

Neglect can be a single incident or it can also be ongoing, repeated failures by the service to meet a consumer’s physical or psychological needs.

You must notify the Commission of any incident of neglect that:

  • happens in your service
  • somebody has alleged happened at your service
  • you suspect may have happened at your service. 

Duty of care is the obligation to take reasonable care to avoid injury to a person who might be injured by something you do, or something you fail to do.

 

What is neglect?

Neglect is:

  • a breach of duty of care to a consumer by a provider or worker
  • a gross breach of professional standards in providing care or services to a consumer. 

Neglect can be a single incident or it can also be ongoing, repeated failures by the service to meet a consumer’s physical or psychological needs.

You must notify the Commission of any incident of neglect that:

  • happens in connection with care that your service provides
  • somebody has alleged happened in connection with care
  • you suspect may have happened in connection with care.

Duty of care is the obligation to take reasonable care to avoid injury to a person who might be injured by something you do, or something you fail to do.

 

Neglect includes:
  • depriving a consumer of basic necessities like food, drink or clothing
  • withholding personal care like showering, toileting or oral care
  • regular late or missed medication
  • failing to administer correct or time-critical medications
  • not supervising a consumer in a dangerous environment such as:
    • leaving a consumer outside in the sun resulting in significant burns
    • leaving a consumer in a vehicle on a hot day which could result in significant harm
    • failing to supervise consumers where they might wander onto a busy road or a body of water
  • not monitoring a consumer’s nutrition and hydration leading to rapid weight loss and clinical complications
  • not seeking appropriate assessment and treatment for a consumer that seems unwell or injured, such as:
    • failing to treat injuries and wounds
    • failure to assess and manage pain
    • failure to call an ambulance when a consumer requires treatment in a hospital
  • not ensuring a consumer is reviewed by a health professional in line with their care plan
  • not modifying a consumer’s meals in line with their care plan or not giving enough assistance at meal time resulting in a consumer not being able to eat or choking.
Neglect includes:
  • not arriving to provide care and services, resulting in harm and/or discomfort to the consumer, e.g. where a worker: 
    • does not arrive to assist a consumer into bed, so the consumer remains in their wheelchair all night
    • fails to deliver meals to the consumer, resulting in the consumer going hungry
    • does not arrive to provide assistance with hygiene and toileting, so the consumer’s continence aids are not changed, resulting in emotional distress 
    • does not arrive to change a consumer’s dressing and their wound worsens as a result. 
  • frequent or regular missed instances of care without prior agreement
  • withholding personal care, such as showering, toileting or oral care
  • withholding agreed outings to community settings, such as not taking a consumer shopping
  • not changing soiled continence aids in a timely manner
  • regularly late or missed medication, or failing to assist a consumer to administer correct or time-critical medications 
  • not supervising a consumer in a dangerous environment or an environment where the consumer may be susceptible to injury, such as
    • failing to appropriately monitor a consumer at risk of falls when out shopping, resulting in the consumer falling 
    • leaving a consumer outside unprotected in the sun resulting in significant burns 
    • leaving a consumer enclosed in a vehicle on a hot day where the temperature is likely to increase rapidly and cause significant harm 
  • not recognising and responding appropriately when a consumer experiences acute deterioration while services are delivered
  • not modifying a consumer’s meals in line with their care plan or not giving enough assistance at meal time resulting in a consumer not being able to eat or choking.

 

Neglect does not include:
  • isolated incidents of missed medication that do not impact the consumer
  • rapid weight loss as a result of a disease (where you have made all reasonable efforts to ensure the consumer is receiving enough nutrition)
  • a consumer knowingly choosing not to receive care and services.
Neglect does not include:
  • isolated incidents of missed medication administration (where the service is responsible for assisting the consumer to administer the medication) that does not impact the consumer
  • rapid weight loss as a result of a disease (where all reasonable efforts were made to ensure the consumer is receiving adequate nutrition)
  • where informed choice is made by the consumer, not to receive care and services that the provider is responsible for delivering 

For example, a consumer chooses not to:

  • have a shower or clean their teeth or brush their hair 
  • have their lawn mowed 
  • have their wound cleaned and dressed
  • not to eat a diabetic diet (for a diabetic consumer).

What is 'in connection with care'?

You must manage and report all incidents (including alleged or suspected incidents) of neglect in connection with care. 

Incidents that occur in connection with care and that have (or could reasonably have been expected to have) caused harm to a consumer or another person, include incidents:

  • that occur while care and services are provided
  • that arise out of a failure to provide care and services 
  • where the harm (or potential harm) is connected to care and services provided, even if the harm did not occur during delivery of service. 

Workers may witness incidents that are not in connection with care. This may include acts committed by members of a consumer’s household or community who are not affiliated with you. While incident management and prevention requirements do not apply to these incidents, it is part of your service’s broader responsibility to protect the safety, health and wellbeing of consumers. You must take protective steps when you become aware of neglect or abuse (including suspected or alleged incidents) of consumers.

If an incident may be unlawful, or if there is any ongoing danger to any person, you should contact the police.

You should also support consumers dealing with elder abuse or other issues by connecting them to further assistance, such as:

  • OPAN (website) – the Older Persons Advocacy Network provides free, confidential, and independent support to older people seeking or receiving care and their families or representatives.
  • 1800 ELDERHelp (1800 353 374) – a free and confidential National Elder Abuse phone line.

 

Work Tool

The SIRS Decision Support Tool can help you explore what kinds of incidents are neglect.

If an incident happens at your service, it can help you to decide whether it must be reported to the Commission, and if it is Priority 1 or Priority 2.

Professional Standards

All workers must carry out their duties in accordance with their job descriptions and their professional knowledge and skills. They must also follow applicable codes of conduct, practice or professional standards.

Workers who are subject to professional standards through registration or accreditation (such as medical, nursing and allied health professionals) will have a higher expected threshold of conduct. When clear breaches of professional standards occur, there are ways to report them to the relevant overseeing agency (for example, the Australian Health Practitioner Regulation Agency - AHPRA).

You can find more details about professional standards and breaches of standards in the Commission’s SIRS Guidelines.

 

Professional Standards

All workers must carry out their duties in accordance with their job descriptions and their professional knowledge and skills. They must also follow applicable codes of conduct, practice or professional standards.

Workers who are subject to professional standards through registration or accreditation (such as medical, nursing and allied health professionals) will have a higher expected threshold of conduct. When clear breaches of professional standards occur, there are ways to report them to the relevant overseeing agency (for example, the Australian Health Practitioner Regulation Agency - AHPRA).

 

The Commission and the Code of Conduct

To help ensure consumers receive high quality care, the government has introduced new national legislation, the Code of Conduct for Aged Care, also known as the Code.

From 1st December 2022, the Code applies to approved providers of residential, home and flexible care services, the governing persons of these providers and all of their workers. You must apply the code across your service and also educate workers on the Code.

The Commission has published detailed information about the Code of Conduct. For additional information, refer to the relevant section of the Commission’s website.

All workers providing Commonwealth-funded aged care services must comply with the Code, which sets out expectations for the safe and ethical delivery for those administrating and providing services.

Warning signs

Incidents of neglect are not always witnessed, and not all affected consumers will report that an incident has happened. 

There are other warning signs that might suggest that an incident has happened at your service. These include when: 

  • a consumer has unexplained weight loss
  • a consumer is more hungry or thirsty than usual
  • a consumer is constantly fatigued or falls asleep at inappropriate times
  • a consumer shows signs of poor hygiene or grooming, like overgrown nails, dirty hair, body odour, continence aids not being regularly changed or wearing dirty and damaged clothes
  • a consumer is wearing inadequate clothing for the weather
  • physical needs not being met, for example:
    • wounds that would not heal or are weeping
    • dirty dressings
    • soaked continence aids
  • hints or statements that seem to be about neglect
  • longing for company, loss of social and communication skills.

You should always investigate when there are changes in a consumer’s behaviour or where these warning signs are shown. 

Remember, if you suspect that a reportable incident has happened you must notify the Commission. You should not wait for definitive proof.

 

Responding to neglect

When an incident happens at your service, your first priority is always to ensure the safety and wellbeing of your consumer. 

For incidents of neglect, this could mean: 

  • reassuring the consumer 
  • immediately attending to unmet needs
  • arranging further assessment and treatment.

While managing the incident you must continue to give the consumer support and practice open disclosure by letting the consumer, or their representative, know the steps you are taking to respond.

 

Reporting neglect

Neglect, like any reportable incident, must be recorded in your IMS and the Commission must be notified. 

If there were reasonable grounds to contact the police, or if there was harm to a consumer that needed medical or psychological treatment to resolve, it is a Priority 1 reportable incident and you must notify the Commission within 24 hours of becoming aware. 

If there were no reasonable grounds to contact the police and no harm to a consumer that needed medical or psychological treatment to resolve, it is a Priority 2 reportable incident and you must notify the Commission within 30 days of becoming aware. 

A quality incident notification requires more than simply transcribing the details from progress notes about the incident or copying text from your IMS. It is important that the person making the notification is familiar with:

  • what happened
  • when the incident happened
  • where the incident happened
  • who was involved including the affected consumer, workers involved with the incident, and other affected people 
  • what actions were taken after the incident
  • what caused the incident (if known)
  • what changes will be made as a result of the incident (if known). 

If you become aware of further information after submitting an initial notification, you should update the Commission. 

When you provide clear and comprehensive information early on, it is less likely that the Commission will need to: 

  • ask for further details 
  • require you to conduct an investigation, or
  • directly investigate the matter itself.
     

Tip

It is easier to make a good quality notification to the Commission if you have the information you need at hand.

Educating workers to report incidents correctly within your IMS will make it easier to notify the Commission when a reportable incident happens.

Work Tool

The fact sheet, Reportable incidents: neglect, provides more detailed guidance for reporting of incidents in a residential service relating to this incident type.

The example Neglect notification shows the level of detail the Commission expects when receiving a notification about this incident type.

You can use the Practical tips guide to ensure your notification contains all of the required information.

Work Tool

The fact sheet, Reportable incidents: neglect, provides more detailed guidance for reporting of incidents in a home or community setting relating to this type of reportable incident.

Contact us

If you have a question about the SIRS, you can call us on 1800 081 549. This phone line is open 9 am to 5 pm (AEST) Monday to Sunday.

You can also email us at sirs@agedcarequality.gov.au.

Facilitated workshops

The Commission provides facilitated workshops to those working in the sector. All current workshops are available on the Commission’s Workshop page.

Online learning

The Commission’s Aged Care Learning Information Solution, Alis provides free online education for employees of Commonwealth-funded aged care providers, including a module covering Neglect.

You can access Alis at learning.agedcarequality.gov.au. 

Disclaimer

The information contained on this page is intended to provide you with general guidance; however, it is your responsibility to be aware of your legislative requirements.