SPECIFIED CARE AND SERVICES REVIEW

18 December 2012

Safety and Emergency Assistance in Specified Care and Services Schedule: RevisedDiscussionPaper

PURPOSE

To discuss safety and emergency assistance issues in the Specified Care and Services Schedule.

BACKGROUND

The Specified Care and Services Reference Group (at its meeting of 26 November 2012) discussed that emergency assistance (Schedule Item 1.12) in response to individual resident medical emergencies and in response to environmental emergencies threatening the resident population of a facility as a whole (e.g. fire, flood, security incidents) should be addressed separately in the Schedule. This version of the paper is revised to capture comment in meetings of the Reference Group and its Sub-Groups to 17 December 2012.

The Reference Group has agreed that emergency assistance in response to environmental emergencies should refer to providers meeting legal requirements for emergency planning and emergency response under applicable law.

The Reference Group has discussed that adequate emergency assistance in response to individual resident medical or clinical emergencies may require a health professional such as a Registered Nurse to be at each facility and onduty 24hours a day every day. Different views were registered whether a Registered Nurse was required, and issues were identified (such as adequacy of funding and personnel supply) with achieving this in some areas or services, highlighting the need for case-by-case exceptions,e.g. to take account of facilities with resident populations with lower care needs and/or in rural, regional or remote areas that will find it hard to source Registered Nurses.

Also attached are two examples of recent judicial and governmental findings and directions about emergency medical assistance in residential aged care facilities: a copy of the Lismore Coroner’s Court (NSW) inquest into the death of MrsMartha McKeeat an aged care facility;and recent SafeWork South Australia directionsto managers of South Australian aged care facilities following South Australian coronial findings into a similar death.

ISSUES

Schedule Item 1.12: Emergency Assistance

‘At least one responsible person is continuously on call and in reasonable proximity to render emergency assistance.’

Residential Care Manual explanatory text:

‘The number of residents and their dependency levels should be considered in deciding the number and qualifications of emergency assistance personnel available.’

Questions – emergency medical assistance

Responsible person number and qualifications of emergency medical/clinicalassistance personnel available to respond to resident medical emergencies:

  • Could minimum qualifications for a responsible person & emergency medical/clinicalassistance personnel be specifically defined?
  • Should there be a defined number of available emergency medical/clinicalassistance personnel to residents?

While not making specific recommendations in relation to staffing levels and staff training, Magistrate R Denes in the coroner’s report on the death of Mrs Martha McKee noted that ‘One carer to the 45 residents … is unsatisfactory even if it meets the legislative requirements’ (paragraph 21), ‘management should ensure that all staff are aware of emergency care protocols and ensure that all staff understand and are competent to perform resuscitation’ (paragraph 27) and ‘organisations that own and operate aged care facilities should be constantly reviewing their staffing needs – not only in terms of complying with legislation or regulations, but in terms of ensuring resident and staff safety’ (paragraph 33).

A SafeWork South Australia notice issued in September 2012 in response to a similar bedpole related death of a resident in a South Australian residential aged care facility states:

‘Employers must ensure that workers are appropriately trained to be made aware that they must immediately check a resident for signs of life in an emergency situation, be competent in performing resuscitations and be aware of all emergency protocols.’

Continuously on-call / available:

  • Should a ‘continuously on-call’or ‘available’ responsible person be expected to be continuously awake during the period he or she is on-call?

Reasonable proximity:

  • Does reasonable proximity require the responsible person to be physically on-site?
  • If not, should reasonable proximity to a facility be measured in response time or physical distance and could this be defined?

The emergency assistance provisions for Indigenous residential aged care services under the Flexible Aged Care Program (which fall outside the framework of the Aged Care Act 1997) require a responsible person to be onsite and awake 24 hours a day every day to provide emergency assistance as needed.

Render emergency assistance:

  • What is it to ‘render emergency [medical/clinical]assistance’ and how does this relate to providingemergency medical services more broadly?
  • What on-site equipment is necessary to render emergency medical/clinical assistance?
  • Is it expected providers should have formal relationships with providers of emergency medicalservices (e.g. acute hospital, ambulance, locum GP) in place?

Regional and Rural issues:

  • Is there a difference between the expected level of emergency assistance in a metropolitan facility and a small regional or rural facility?
  • What would justify any difference in expected level of emergency assistance?

Other considerations – advance care directives:

  • Should a specific reference to providing emergency assistance in accordance with advance care directives be included in the Schedule?

RECOMMENDATION

It is recommended that theReference Group and its Sub-Groups:

  • noteMagistrate R Dene’s findings in relation to the death of Mrs Martha McKee;
  • note SafeWork South Australia’s directions to South Australian aged care providers;
  • discuss the issues raised in this paper.

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