Unexplained absences in residential 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 careers have a duty of care to ensure residents and clients are safe and accounted for at all times, 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 (Ageing and Aged Care 2017).

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

Enabling consumers to move about as freely as possible, whilst maintaining a safe environment, is directly tied to Standard 5 of the Aged Care Quality Standards: Organisation’s Service Environment.

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 - irrespective of whether the police are actually contacted or not.

(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 and it is not considered a reportable incident (ACQSC 2021).

Who is at Risk of Going Missing?

Residential care clients should be empowered to retain a certain level of independence that is appropriate to them, for as long as possible, and this may involve being able to come and go freely, providing somebody is notified and the correct processes are followed (Aged Care Quality and Safety Commission 2019).

There are, however, some more vulnerable residents who are at a high risk of unexplained absence. These include:

• New residents;
• People receiving respite care;
• Residents who have a history of wandering;
• People living with dementia.

(NEU 2015; Aged Care Guide 2017)

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.

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

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

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

Steps for when a resident is missing:

1. Notify the person in charge, such as the facility manager.
2. Review the visitor’s log for any missed communication, or further clues.
3. Conduct a search of the facility, including all rooms, yards, storage areas and smaller spaces, such as cupboards and under beds.
4. Notify the missing person’s relatives.
5. Review the resident's files for clinical and behavioural information to assist in location.
6. Conduct a more thorough search of the facility and surrounding streets.
7. If there are reasonable grounds for notifying the police, you must do so within a reasonable timeframe.
8. 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.

9. From this point onward, the police will take any necessary action to locate the missing resident in consultation with the facility’s management.
10. Ensure the incident is documented in your organisation's Integrated Management System, and the resident's care plan.

(NEU 2015; Ageing and Aged Care 2017; ACQSC 2021)

How to Notify the Commission

Notifications to the Commission need to be made electronically through the My Aged Care Service and Support Portal. This can be accessed from: https://www.health.gov.au/resources/apps-and-tools/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 not involved in returning the resident home (NEU 2015; Ageing and Aged Care 2017).

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

Following the Incident

As soon as is practically possible, complete an incident report as per your facility’s policy (Ausmed Editorial Team 2019). Include all relevant documentation, including times, names of the person who identified the resident as missing, the steps taken to recover them, etc.

The client’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 client should receive ongoing regular monitoring and observational checks after the incident to prevent a repeat scenario (NEU 2015; Prabs_k 2011).

Reducing the Risk of Missing Patients

Steps and features you and your organisation can adopt to reduce the risk of a missing resident could include:

1. One-way locking doors with keypads at each entrance;
2. Identity bracelets or cards;
3. Movement alarms and sensors throughout the facility;
4. Walking groups and social programs;
5. Thorough screening and assessment of new residents;
6. Regular communication with family members;
7. Close monitoring and observation of any new or at-risk residents.

(NEU 2015; Prabs_k 2011)

Additional Resources

• Aged Care Quality Standards: https://www.agedcarequality.gov.au/providers/standards.
• Unexplained Absence Report Form: https://agedcare.health.gov.au/.../unexplained-absences-report.

References