Behaviour Support Plans – Are you ready for 1 September 2021?

Approved providers are familiar with care and services planning. It is a requirement under the Aged Care Quality Standards: Standard 2, that approved providers undertake initial and ongoing assessment and planning for care and services in partnership with the consumer. However, from 1 September 2021, certain approved providers will be expected to have in place a Behaviour Support Plan for any care recipient that requires behaviour support. This will form part of that care recipient’s existing care and services plan.

Introduction

Earlier this year, the Aged Care Act 1997 (Cth) (Act) was amended to implement three measures in response to recommendations of the Royal Commission into Aged Care Quality and Safety (Royal Commission), and in the case of restrictive practices, in response to the Independent Review of Legislation Provisions Governing the use of Restraint in Residential Aged Care. Amongst these measures was the insertion of a new definition of restrictive practices into the Act to bring practice into line with the disability sector. Approved providers would be aware that the Quality of Care Principles 2014 (Principles) were also amended to supplement the aged care reforms introduced into the Act. Specifically, since 1 July 2021, approved providers have borne additional responsibilities in relation to the use of restrictive practices.

From 1 September 2021, the next phase of requirements under the Principles will commence. From this date, approved providers specified in the Principles will be expected to have developed a Behaviour Support Plan for every consumer who exhibits behaviours of concern or changed behaviours, or who has restrictive practices considered, applied or used as part of their care. To date, providers of residential care or flexible care in the form of short‑term restorative care provided in a residential care setting are subject to these new requirements. For many providers, this will require a significant undertaking. Importantly, Behaviour Support Plans do not replace the care and services plan, but instead form part of it.

The Aged Care Quality and Safety Commission (ACQSC) describes Behaviour Support Plans as:

“a plan for a consumer, made in accordance with the [Quality of Care] Principles, that sets out information regarding any changed behaviours (also known as ‘behaviours of concern’) for that consumer, including all alternative strategies which have been tried prior to the use of any restrictive practice for that consumer. The Principles set out the responsibilities of the provider relating to Behaviour Support Plans, including assessments and documentation which should be prepared and included.”

What information should be set out in a Behaviour Support Plan?

Certain information set out under the Principles must be included in Behaviour Support Plans. This includes, but is not limited to:

• Information about the care recipient that helps the approved provider to understand the care recipient and their behaviour;
• Any relevant assessments of the care recipient;
• Information about behaviours of concern for which the care recipient may need support;
• Information about each occurrence of behaviours of concern for which the care recipient has needed support;
• Alternative strategies for addressing behaviours of concern;
• Any alternative strategies that have been considered for use, or have been used in respect of the care recipient and the effectiveness of those strategies;
• A description of the approved provider’s consultation about the use of alternative strategies in relation to the care recipient with the care recipient or the care recipient’s representative.

Behaviour Support Plans and the use of restrictive practices

If the use of a restrictive practice is assessed as necessary by an approved health practitioner, aBehaviour Support Plan must set out the following:

• the care recipient’s behaviours of concern that are relevant to the need for the use of the restrictive practice;
• the restrictive practice and how it is to be used;
• alternative strategies that must be used before using the restrictive practice;
• how the use of the restrictive practice is to be monitored and reviewed;
• a description of the approved provider’s consultation about the use of the restrictive practice with the care recipient or the restrictive practices substitute decision-maker for the restrictive practice; and
• a record of informed consent for the use of the restrictive practice obtained from the care recipient or the restrictive practices substitute decision-maker for the restrictive practice.

It is important to note that approved providers are expected to document how they have monitored and reviewed the use of a restrictive practice for a care recipient. This ensures that the care recipient, their nominated representative and aged care staff all understand the conditions of the use of the restrictive practice. Approved providers must review care recipients’ Behaviour Support Plans on a regular basis and as soon as practicable after any change in the care recipient’s circumstances. This may require the approved provider to make necessary revisions to a Behaviour Support Plan.

If a restrictive practice is used, approved providers must record the following information in a care recipient’s Behaviour Support Plan:

• the restrictive practice being used and how it was used;
• if the restrictive practice is only to be used on a needs basis, the behaviours of concern that led to the use of the restrictive practice and any alternative strategies that were used prior to the restrictive practice;
• details of any persons involved in the use of the restrictive practice;
• a description of any engagement with external support services;
• details of the monitoring of the use of the restrictive practice; and
• the outcome of the review of the use of the restrictive practice.

The use of a restrictive practice in an emergency requires approved providers to document additional information in the care recipient’sBehaviour Support Plan. Approved providers should also be wary that detailed information is required to be documented in a care recipient’s Behaviour Support Plan if the need for ongoing use of a restrictive practice is indicated.

Consultation

In preparing, reviewing or revising Behaviour Support Plans, approved providers must consult with:

• the care recipient and any other person nominated by the care recipient (unless the care recipient lacks the capacity to be consulted);
• if the care recipient lacks capacity to be consulted, a person or body able to make decisions about the care of the care recipient under the law of the State or Territory in which the care recipient is provided with aged care;
• any health practitioners with expertise relevant to the care recipient’s behaviours of concern.

Oversight

It is important to note that the ACQSC is monitoring and investigating provider compliance with the restrictive practices requirements set out in the Principles. Where an approved provider may or may not be complying with its restrictive practices obligations, the ACQSC has the power to take enforceable regulatory action. Documentation of the use of restrictive practices in accordance with a care recipient’s Behaviour Support Plan can be used as evidence of compliance, or lack thereof, in relation to the use of restrictive practices. It is also worth noting that the use of a restrictive practice in relation to a residential care recipient – other than in circumstances set out in the Principles – is a reportable incident under the Serious Incident Reporting Scheme (SIRS).

Conclusion

The introduction of Behaviour Support Plans is intended to ensure that restrictive practices are only used as a necessary and proportionate response to a care recipient’s circumstances, and to protect the rights of care recipients. Early identification of behaviours of concern, open communication with relevant parties, and robust documentation will ensure that approved providers are best placed to discharge their responsibilities under the Act and Principles. It would be prudent for approved providers to ensure that existing policies and procedures contemplate the regular use of Behaviour Support Plans, and that staff, care recipients, representatives, family and health practitioners are all aware of these new requirements.

We are here to help

Our team can assist you in preparing for the introduction of Behaviour Support Plans including: advising on your obligations, undertaking reviews of current policies and procedures, and preparing or reviewing tailored documentation to assist in the practical implementation of Behaviour Support Plans within your organisation.

Please send an email to vharcourt@rk.com.au if you would like further information or assistance about Behaviour Support Plans to meet your regulatory compliance obligations.