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5 Tips for Safety

  1. Provide time for staff to record and share information on clients in an effective and timely manner
  2. Streamline the incident reporting process. High fre­quency inci­dents should be quick to report.
  3. Nurture the culture of reporting of all incidents and near misses.
  4. Provide training on a regular basis to achieve a level of competency to manage the safety challenges.
  5. Make it a priority to find the time today for a safer tomorrow.


Consider this hypothetical case study.

Anne usually worked 12 hours per week on a casual basis for Tulip Aged Care Facility. Anne also did casual shifts at two other residential aged care facilities. She averaged 35 hours in total per week across her three employers.

Over the last 16 years, Anne had gained a lot of experience caring for and supporting residents, including managing their behaviours of concern.

Victor, one of the residents Anne cares for from time to time, had been increasingly confused which had led to occasional outbursts of frustration and verbal aggression. Anne felt that Victor had started to stand inappropriately close to her at times too.

Anne spoke about this to a colleague. She did not tell her manager or submit an incident report as she thought this was typical for a person with dementia. Anne had seen more serious behaviours from other residents in the past.

One morning while helping Victor to get ready for breakfast, Victor started to verbally abuse Anne. He grabbed her aggressively by the arm and would not let her go. Fearful of being hurt, Anne tried hard to get away. Victor loosened his grip. Anne tripped and fell to the ground painfully injuring her shoulder.  Other staff heard the commotion and came to assist.

Anne later required surgery for her injured shoulder.

The review of the incident found no one had submitted an incident report regarding Victor’s escalating behaviours of concern.

From the National Report: Home Care, Com­mu­nity Care and Out­reach Staff Safety Sur­vey 2013 (Survey), staff are facing an average of 1.2 incidents per month but only 16% of casual and part time staff reported incidents to their organisations. What does this say about the remaining 84%?

Under reporting of incidents by all staff presents obvious issues for the organisation, for individual managers, and for the staff and clients involved in the incidents.

Minor acts of aggression are often precursors to more serious acts of aggression. It is interesting to ponder why high frequency incidents are the ones that seem to be the least likely to be reported.

“This (aggressive) behaviour is expected and normal for the client to display.” (Survey respondent)

“I didn’t realise getting locked in was considered abuse and worth reporting.” (Survey respondent)

There are many contributing factors inhibiting the reporting of incidents. There are just as many reasons why staff should invest time in reporting incidents.

Incident reporting for effect rather than merely compliance will identify escalating and de-escalating trends and the prevalence of minor (e.g. no one is physically injured) and often high frequency incidents. This will enable supervisors and managers to understand what (or who) is and is not working well in order to allocate adequate resources to mitigate the foreseeable risk of physical, emotional and psychological harm.

From the Survey, 23% of incidents of aggression and/or violence involving casual or part time workers resulted in the casual or part time worker suffering a psychological injury, even if no physical harm had been suffered.

If I was to take a fall today and injure my shoulder like Anne did, it is clear what inci­dent caused the injury and for whom I was work­ing for at the time of the inci­dent. There­fore it is also clear who will be pay­ing the work­ers com­pen­sa­tion claim.

It will not always be so clear which par­tic­u­lar incident(s) con­tributed sig­nif­i­cantly to a worker’s psy­cho­log­i­cal injury and for which employers the worker was working for at those times. In this case study, Tulip Aged Care Facility will be paying workers compensation for Anne’s psychological injury even if the injury was contributed to by other incidents at Anne’s other places of employment.

Over the two days prior to the incident Victor had been upset about his son travelling overseas without taking Victor with him. This had not yet been added to Victor’s care notes. Unaware it might be a potential trigger for Victor, Anne had asked Victor about his family on the morning of the incident.

Time pressure can mean staff have difficulty finding time to share their knowledge effectively with their colleagues about residents. This can be more evident with casual and part time staff who may be less familiar with the residents they are supporting. Without up to date information, staff miss the opportunity to use the best strategies for the wellbeing of the resident and the safety of all.

Following surgery Anne’s physical wounds began to heal and Tulip Aged Care Facility offered Anne light duties to help Anne to successfully return to work.

Even with the light duties, Anne was anxious about returning to work. Prior to the incident, Anne thought she knew the residents well and how to de-escalate any behaviours of concern. The incident with Victor shook her confidence. She was now fearful that something worse might happen and she would not be able to manage her own safety.

After a week back at work, Anne was very distraught and requested to take further time off. She was not sure if she would ever feel safe enough to return to work.

For Anne, her return to work was postponed due to her psychological injury rather than her physical injury.

Anne submitted a workers compensation claim to Tulip Aged Care based on Anne working 35 hours per week, and not just the 12 hours per week that Anne worked for Tulip Aged Care. Management at Tulip Aged Care were surprised to find they were liable for all work Anne is unable to do as a result of her injury sustained at Tulip Aged Care regardless whether those hours are usually performed for Tulip Aged Care or another employer.

Anecdotally casual staff are less inclined to claim workers compensation than their full time colleagues. This is partly because of the fear of repercussions such as reduced shifts. As a casual worker moves closer to retirement age, these perceived repercussions will be less of a concern when submitting claims for workers compensation.

Less than one third of respondents to the Survey felt very well prepared to manage their safety in the event of an incident involving aggression and/or violence in the future. In time, staff who feel their employer provides an unsafe work environment will look elsewhere for other employment opportunities. Wouldn’t you?

To improve staff retention, to be regarded as an employers of choice, and to minimise the likelihood of an incident such as Anne’s, empower your staff through education and skill enhancement to make good decisions about their own safety.

When given the skills to employ redirection techniques and de-escalation techniques early, and to set boundaries where appropriate, staff will make better decisions about their safety. Fortunately once acquired skills such as these are reinforced daily.

Consider all the benefits of casual and part time staff versus some of the risks. Less knowledge of residents may result in avoidable incidents. Incidents suffered at other workplaces may compound the consequences of incidents at your workplace. Also, injured casual and part time staff will not be able to work for their other employers so your organisation will be exposed to more expensive compensation claims.

Are we too casual? That is for you to answer.

Like all elements of the aged care workforce, we need to find the right balance between the business benefits and the associated risks.


This article was first published in the January 2015 edition of Australian Ageing Agenda.


Should you wish to discuss strategies to manage aggressive behaviours affecting you or your team, please feel welcome to contact Holland Thomas & Associates.

Travis Holland 1

Travis Hol­land
Man­ag­ing Direc­tor
Hol­land Thomas & Asso­ciates
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