When a loved one moves into aged care, families expect them to receive kind, respectful, and safe support. Sadly, incidents can occur where physical contact crosses the line from necessary assistance to harmful conduct. Understanding what constitutes "unreasonable use of force" is foundational for residents, families, and care providers alike. This incident type is serious and must be reported under the Serious Incident Response Scheme (SIRS).

Defining the Boundary: From Care to Conduct That Causes Harm

The term "unreasonable use of force" refers to unwarranted or unjustified physical contact with a consumer that has the potential to cause harm. This is not just limited to obvious assaults; the range of inappropriate contact can be wide. As highlighted in related materials, it can range from rough handling of a consumer to a deliberate and violent attack.

The core issue lies in whether the physical contact was necessary and appropriate for the circumstances of care. If the force used is excessive, unjustified, or serves no therapeutic purpose, it may meet the criteria for being unreasonable.

Examples of unreasonable use of force include:

• Rough handling: Jerking a resident's arm, pulling them aggressively, or pushing them unnecessarily during transfers or personal care tasks.
• Shoving or pushing: Any physical application of force to move a resident without justification, especially if it causes distress or risk of injury.
• Physical assault: Intentional, aggressive acts of violence towards a resident.

It is important to differentiate between physical contact needed for safe care (such as assisting a resident to stand) and contact that is unwarranted. Care workers are trained to assist residents with mobility and personal hygiene using techniques that maintain safety and dignity. When those professional standards are breached by carelessness or aggression, the action becomes unacceptable and reportable.

The Role of Reportable Incidents and the SIRS

In Australia, the Aged Care Quality and Safety Commission oversees the Serious Incident Response Scheme (SIRS). This scheme mandates that providers record and notify the Commission about specific types of incidents that occur or are suspected of occurring to people receiving aged care. Unreasonable use of force is one of the eight specific incident types that must be reported.

The goal of SIRS is to improve the safety and wellbeing of older Australians by ensuring that providers manage and learn from serious incidents. When an incident of unreasonable use of force is suspected or occurs, the provider must take immediate steps to respond to the incident and record it in their Incident Management System (IMS).

Categorizing the Severity: Priority 1 vs. Priority 2

The SIRS requires providers to assess the severity of a reportable incident, classifying it as either Priority 1 or Priority 2. This classification determines the urgency of notification to the Commission.

Priority 1 Incidents require notification to the Commission within 24 hours of the provider becoming aware of the incident. An incident of unreasonable use of force falls under Priority 1 if:

1. It resulted in a physical or psychological injury or discomfort that required medical or psychological treatment to resolve.
2. There were reasonable grounds to contact the police (i.e., if it is suspected to be a criminal act).

If the unreasonable use of force causes a measurable harm requiring professional intervention, it is a Priority 1 incident, necessitating quick action from the provider and rapid notification to the Commission.

Priority 2 Incidents must be reported to the Commission within 30 days of the provider becoming aware of the incident. These are incidents that are serious but do not meet the criteria for Priority 1. Even if the immediate physical harm is minor, the act itself remains a serious failure of care that must be addressed.

The Impact of Unreasonable Force

The consequences of unreasonable use of force extend far beyond physical injury. Residents who experience rough handling or physical aggression often suffer significant psychological and emotional distress. They may become withdrawn, anxious, or fearful of their care providers, severely impacting their overall wellbeing and quality of life.

For care staff, adhering to proper conduct and training is paramount. Any staff conduct that involves physical aggression, neglect, or unnecessary force seriously jeopardizes the trust relationship between the consumer and the provider. Providers must have clear staff conduct policies and robust training programs addressing the prevention of all forms of mistreatment, including unreasonable use of force.

When allegations of this nature surface, providers are required to investigate them thoroughly, whether the incident is confirmed, alleged, or merely suspected. This includes incidents involving people using aged care, even those with cognitive impairments who may struggle to report the incident themselves.

Reporting and Protection

The law protects individuals who report reportable incidents—a process known as 'disclosure.' This protection extends to workers, consumers, families, volunteers, and advocates. If a staff member or other individual witnesses or suspects unreasonable use of force, they are encouraged to report it, knowing they are legally protected from retribution under the Aged Care Act 1997.

For families who suspect unreasonable use of force, the following steps are generally advised:

1. Immediate Reporting to the Provider: Inform the residential manager or a senior staff member immediately about the concern.
2. Contacting Police (If Criminal): If the incident appears criminal (e.g., a serious assault), contact the police directly.
3. Reporting to the Commission: Contact the Aged Care Quality and Safety Commission to report the reportable incident.

Quick reporting allows for rapid investigation and action, which is vital for resident safety. Providers are responsible for managing the incident, but external reporting ensures accountability and regulatory oversight.

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Prevention Through Education and Culture

The most effective way to prevent unreasonable use of force is by establishing a culture of respect, dignity, and appropriate professional conduct within the aged care setting. This starts with:

• Training: Regular, mandatory training for all staff on appropriate manual handling techniques, de-escalation strategies, and the recognition and reporting of mistreatment.
• Supervision: Proper supervision of care staff, particularly those new to the role or working with residents who display responsive behaviours.
• Clear Policies: Written policies that unambiguously define what constitutes unacceptable physical conduct and the disciplinary actions that follow breaches of these standards.
• Resident-Centered Care: Focusing on individualized care plans that account for a resident's physical and psychological needs, reducing situations where frustration or force might arise.

When staff members feel supported, well-trained, and respected, they are better equipped to deliver support without resorting to inappropriate physical actions. Consistent focus on professional boundaries and respect for the consumer's rights reduces the risk of these serious incidents. The breakdown of force definition, providing instances of what crosses the line from support to mistreatment, must be a standard part of staff induction and ongoing professional growth.

In conclusion, unreasonable use of force is a serious transgression of trust and professional standards in aged care. By clearly defining the boundary, adhering to strict reporting mechanisms like SIRS, and cultivating a positive safety culture, the aged care sector works towards its ultimate mission: supporting older Australians with dignity and protection.