Unexplained absences in residential aged care are a relatively common event.

Despite their regularity, instances of unexplained absences and missing residents should always be taken seriously. It is not unheard of for a resident’s condition to decline or even lead to death after an unexplained absence (Woolford et al. 2018).

Not only do aged care workers have a duty of care to ensure residents are safe and accounted for at all times, but it’s also legislated that under the Aged Care Act 1997, an unexplained absence or missing resident is the responsibility of the approved care provider.

An unexplained absence from care is also a reportable incident under the Serious Incident Response Scheme (SIRS) (ACQSC 2022).

What is Classified as an Unexplained Absence?

Section 25 of the Accountability Principles 2014 defines an unexplained absence as when a care recipient is absent from a residential care service and the absence is unexplained or the service is unaware of any reasons for the absence.

Under the SIRS, an unexplained absence is a reportable incident when:

• A resident is absent from care, and
• The absence is unexplained, and
• There are reasonable grounds to report the absence to the police, regardless of whether the police are actually contacted.

(ACQSC 2021)

Note: If a resident is absent but returns to care before you notice they were missing, you do not need to notify the Commission unless the police were aware of the absence or involved in the person’s return (ACQSC 2021).

Unexplained Absences and Missing Residents Under the Strengthened Aged Care Quality Standards

Standard 7: The Residential Community - Outcome 7.1: Daily living under the strengthened Aged Care Quality Standards (Action 7.1.3) requires aged care providers to establish strategies for protecting older people’s physical safety. Naturally, this would involve ensuring that residents are always accounted for (ACQSC 2024a).

Who is at Risk of Going Missing?

Residents should be empowered to retain a certain level of independence that is appropriate to them for as long as possible. This may involve being able to come and go freely, provided somebody is notified, and the correct processes are followed.

There are, however, some vulnerable residents who are at a higher risk of going missing. These include:

• New residents (especially within the first month of entering residential care)
• People receiving respite care
• Residents who entered residential care unwillingly or unhappily
• Residents who have a history of wandering
• People living with dementia.

(ACQSC 2022, 2023)

When a Resident is Missing

A missing resident is a reportable incident. If you suspect a resident is missing, you are obliged to report this to your facility.

If the absence meets the requirement of a reportable incident under the SIRS, it will also need to be reported to the Aged Care Quality and Safety Commission. Unexplained absences are Priority 1 incidents, meaning the Commission must be notified within 24 hours of the provider becoming aware of the incident (ACQSC 2022).

Each care facility will have a specific policy and process to follow when a resident is found to be missing.

The following framework is only intended as a supplementary guide. It is essential that you are familiar with your facility’s policy and procedure for recognising and responding to a missing resident.

Steps for when a resident is missing:

• Notify the person in charge, such as the facility manager.
• Review documentation (e.g. the visitor’s log) for any missed communication or further clues.
• Contact the resident’s family/carer/guardian to make sure they have not taken the resident out without notifying the provider.
• Conduct a search of the facility, including all rooms, yards, storage areas and smaller spaces, such as cupboards and under beds.
• Notify the missing person’s relatives.
• Review the resident's files for clinical and behavioural information to assist in location.
• Conduct a more thorough search of the facility and surrounding streets.
• If there are reasonable grounds for notifying the police, you must do so within a reasonable timeframe.
• If there are reasonable grounds for notifying the police, the incident must be reported to the Aged Care Quality and Safety Commission as soon as reasonably practicable and within 24 hours of becoming aware of the incident.
  • From this point onward, the police will take any necessary action to locate the missing resident in consultation with the facility’s management.
• Ensure the incident is documented in your organisation's integrated management system and the resident's care plan.

(WACHS 2019; ACQSC 2021)

How to Notify the Aged Care Quality and Safety Commission

Notifications to the Commission need to be made electronically through the My Aged Care Service and Support Portal.

When a Missing Resident is Found

When a resident is returned to the facility, immediately notify your manager in charge and anyone else coordinating the search. The resident’s family should also be notified, if they are not already aware, as well as the police, if they were aware of the absence and not involved in returning the resident home (WACHS 2019).

An appropriate health assessment of the resident should be conducted by your facility’s medical practitioners to ensure they are unharmed or to see if they require further medical examination (WACHS 2019). If further treatment is indicated, an ambulance may need to be called.

Following the Incident

As soon as is practically possible, complete an incident report as per your facility’s policy. Include all relevant documentation, including times, names of the person who identified the resident as missing, the steps taken to recover them, etc.

The resident’s personal management plan records should also be updated with documentation of the incident. If the resident was not already noted as ‘at risk of wandering’, their documentation should be updated. The resident should receive ongoing regular monitoring and observational checks after the incident to prevent a repeat scenario.

Reducing the Risk of Unexplained Absences

The following strategies may be adopted to reduce the risk of unexplained absences:

• Performing effective assessments of residents
• Providing support and supervision where required
• Ensuring effective communication processes
• Performing individualised risk assessments
• Encouraging residents to carry a mobile phone or identity card with the provider’s address and contact number
• Doors with keypads
• Identity bracelets
• Movement alarms and sensors
• Secure fencing
• Sensor mats.

(ACQSC 2023; WACHS 2019)

When implementing measures to reduce the risk of unexplained absences, it’s important to remember that residents have the right to freedom of movement. If this freedom is not afforded, this is a form of environmental restraint. For this reason, removing a resident's free access to the community is only appropriate if the resident is at significant risk of harm (ACQSC 2023).

This is also stated in Standard 4: The Environment - Outcome 4.1b: Environment and equipment in a service environment (Action 4.1.2b) of the strengthened Aged Care Quality Standards, which requires aged care service environments to allow older people to move freely both indoors and outdoors (ACQSC 2024b).

For more information on the lawful use of restrictive practices, see the Ausmed Article Minimising Restrictive Practices in Aged Care: Rules and Regulations.

References