Death Procedures
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MODULE
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Support workers
ADHC support workers include:
• Disability support workers; • Nursing staff; • Line managers.
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Support services
Support services include:
• Large Residences; • Specialist Supported Living services; • Assisted Boarding Houses; • Group homes; • Centre-based respite; • In-home accommodation support.
Assisted Boarding Houses
Assisted Boarding Houses are required to follow these Procedures as specified in the Assisted Boarding Houses Authorisation and Monitoring Manual.
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Apply first aid and call an ambulance
If the person is unresponsive or unusually unwell:
• The support worker holding a first aid qualification starts first aid; • Immediately call an ambulance using 000; • Inform the ambulance if the person has a current medically authorised Resuscitation Plan or Advanced Care Directive; • First aid is continued until the ambulance arrives.
Notify the line manager
You must ensure that a relevant manager is notified of the situation, this can be:
• Direct line manager; • Senior manager; • On call manager.
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Hand over to the attending ambulance officers
On arrival of the ambulance:
• Responsibility for continuing first aid is handed over to the attending ambulance officers; • The person's Advance Care Directive and / or Resuscitation Plan must be provided to the ambulance officers, if applicable, and informs the ambulance officer of the person's wishes regarding resuscitation; • The officers will access the NSW Ambulance Palliative or Authorised Care Plan online, if the person's GP or treating medical officer had previously lodged one.
Further information on Advance Care Directives can be found in the End of Life Care Planning Guidelines.
Notify the manager and the person's family / guardian
If the person is admitted to hospital, you must first notify the line manager and the person's family / guardian, and then:
• Provide the hospital with the person's Hospital Support Plan; • Ensure any disability support required is negotiated between ADHC and the hospital, according to the Hospitalisation Guidelines and the person's Hospital Support Plan.
You must provide support to ensure the person's wishes concerning end of life care are followed, where a person has an End of Life Care Plan.
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ADHC management must be notified
The process for notifying management is for:
• You to report the death to the manager or on call manager; • The manager to report the death to the Director Disability Operations; • The Director Disability Operations to notify the Executive Director Disability Operations.
Senior management will provide advice
Senior management must then provide advice and support to the appropriate manager to:
• Notify the next of kin or guardian; • Notify the Police; • Develop the Briefing Note.
Responsibility will be delegated
The Manager, Accommodation and Respite is the central point of contact, and will delegate responsibility to the Coordinator and Team Leader as appropriate.
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Manager
In ADHC operated disability services, manager refers to:
• Team Leaders; • Coordinators Accommodation and Respite; • Registered Nurse Unit Managers; • Nurse Manager Accommodation and Nursing Services; • Any manager in the reporting line.
Notify the next of kin or guardian
The manager is to notify the next of kin or guardian in person, where possible:
• When and where the person died; • That the death will be reported to the Police who will inform the State Coroner; • That the death will be reported to the NSW Ombudsman.
For Aboriginal or Torres Strait Islander people, it is important for the family to identify the appropriate member of the family and advise them of the matters surrounding the death. It may be inappropriate for a staff member to inform the family as this could be a breach of cultural protocol. It may also be a breach of protocol for a non-Aboriginal person to inform the identified family member of the death and this may need to be done by another Aboriginal person.
Appropriate process
Prior to notifying next of kin, ring in advance and state a situation has occurred and that you need to come and speak with them. Ask the next of kin if they would like to arrange a support person to be with them whilst you meet with them.
In the case where face-to-face notification cannot occur, inform the next of kin over the phone that a situation has occurred and ask if they would like to arrange a support person of their choice to be present prior to giving notification.
In the case where the next of kin do not arrange a support person at the time of the notification, ensure that support is arranged immediately afterwards.
Refer to the person's End of Life Care Plan
Information on the person's and the family's wishes in the event of death should be documented in the person's End of Life Care Plan.
If the person did not prepare an End of Life Care Plan, the manager will liaise with the next of kin or guardian to determine:
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• If they require an interpreter service; • The need to observe any cultural or religious practices or taboos; • Whether the family or others wish to view the deceased person; • A suitable time to view the deceased person before transportation to the State Coroner. Alternatively, viewing times may be arranged with the State Coroner or funeral director.
If requested, allow access for family and significant others to come and visit the house
The person's family and significant others may choose to visit the house to view the person's bedroom and belongings.
To facilitate this, ensure the person's bedroom and belongings remain how they were left.
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Support
Support for another person with disability, includes:
• An advocate or person of their choice; • Legal representation, if necessary.
Identify the person
The person must be identified by either:
• Family; • A friend; • The manager; • An ADHC employee who knows the person.
Note 1
Under the Law Enforcement (Powers and Responsibilities) Regulation 2005, a vulnerable person as defined in Regulation 24 (person with disability) is entitled to have a support person present when a person is being interviewed by police (Regulation 27).
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The support person does not have the same function as the 'person responsible' and will not make decisions for the person with disability. However, it is:
• Someone who is a guardian; or • Any other person who is responsible for the person; or • A relative or friend who has the consent of the detained person to be their support person.
A support person's role during an investigation procedure is to assist and support the person, observe whether or not the interview is being conducted fairly, and to identify any communication problems with the person.
Note 2
The manager of an Assisted Boarding House is required under the Boarding House Act to inform FACS as soon as is reasonably possible (preferably within 24 hours), about the death of a person from an Assisted Boarding House, as outlined in the Assisted Boarding Houses Authorisation and Monitoring Manual.
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Transported to the morgue
The NSW Police are responsible for placement of an identification tag and arranging transportation of the deceased to the State Coroner.
Temporarily absent
A person is temporarily absent when, for example, they are:
• In hospital; • In an aged care facility; • Staying with family or friends.
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Serious incidents
Serious incidents include:
• Serious illness; • Serious injury; • Dangerous incident (an incident that exposes a worker or any other person to a serious risk to health or safety); • The death of a person arising out of work carried out by a business undertaking or workplace.
This includes the death or serious injury of a person living in an ADHC operated or funded service or in an Assisted Boarding House.
Preserved
The manager is responsible for ensuring that the site where the incident occurred is left undisturbed, so far as possible.
An incident site may be disturbed to:
• Assist an injured person; • Remove a deceased person;
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• Facilitate a Police investigation; • Make the site safe or to minimise the risk of a further 'notifiable incident'; • Follow direction given either in person or by telephone by a WorkCover officer.
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Incident Report Form
The Incident Report Form is completed by a support worker and the manager who was notified at the time of the person's death. Refer to the FACS Incident Reporting and Management Policy and Guidelines for people accessing Ageing and Disability Direct Services (November 2014) for assistance when completing the Category 1 Incident - Executive Briefing Form for an unexpected death.
Information for completing the Incident Report Form can be found in the FACS Incident Reporting and Management Policy and Guidelines for people accessing Ageing and Disability Direct Services, November 2014.
Client Death Notification (CDN) Form
The CDN form is used to notify the death of a person in an accommodation support service and can be completed either electronically or by hand. Both versions are available of the ADHC intranet, and on the Service Provider Portal for ADHC funded disability services and Assisted Boarding Houses.
Letter provided to the Police and the State Coroner
ADHC operated accommodation support services are to attach copies of the letters written to the NSW Police and the State Coroner to the Briefing Note.
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Other documentation
Copies of specific documentation relating to the deceased person are required in their most current format to accompany the CDM form. This documentation includes the person's:
• Nutrition and Swallowing Risk Checklist; • My Health and Wellbeing Plan or any other health care plan; • Lifestyle Plan; • Epilepsy Management Plan, if applicable; • Asthma Plan, if applicable; • Palliative Care Plan, if applicable; • End of Life Care Plan, if applicable; • Advance Care Directive or Acute Resuscitation Plan, if applicable.
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NSW Ombudsman
The following frame provides guidance for responding to the NSW Ombudsman following the death of a person.
Relevant ADHC business areas
Business areas and systems that may require notification include:
• Aids and Equipment in Supported Accommodation (AESA) Committee, to return items purchased through this scheme to the AESA aids and equipment pool; • Businesslink to cancel residency charges; • Internal therapy appointments; • CIS to register the date of death of the person.
Relevant external services
External services that may require notification, include:
• Day placement / work program; • Medicare; • Financial institutions and managers;
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• NSW Trustee and Guardian (formerly known as the Office of the Protective Commissioner) for people under Banker Arrangements; • Dentist; • Doctor; • Allied Health Professionals; • Health Funds; • Clubs / groups the person belonged to; • Subscriptions.
The Death Certificate may be required as evidence of the person's death when notifying external services.
Note
If the death is unexpected, a copy of the briefing note, incident report and attachments is sent to FACS Legal for information.
The FACS Performance Improvement Unit forwards all briefing notes and attachments to the NSW Ombudsman to notify of the person’s death.
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ADHC operated disability services
If the Ombudsman’s request is about an ADHC operated accommodation support service it will be managed by the Performance Improvement Unit (PI).
• PI will forward the documents to the relevant Executive Director Disability Operations, and send a copy to FACS Legal • PI will liaise with the relevant Executive Director Disability Operations and arrange for the request to be investigated, and can seek advice from FACS Legal about the information the District is legally required to provide.
The response is submitted to the Deputy Secretary, Disability Operations.
Copies of all original documents are to be retained in a temporary file at the service where the deceased person resided.
ADHC funded disability service
When the NSW Ombudsman requests information about a reviewable death, the ADHC funded disability service is required by the due date to:
• Provide a response;
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• Include an assessment of compliance with ADHC policy and conditions of funding agreement; • Mark as confidential and a Reviewable Death Matter; • Forward to the Executive Director Disability Operations; • The Executive Director Disability Operations forwards it to the Deputy Secretary Disability Operations at Performance Improvement.
Copies of all original documents requested by the Ombudsman are to be retained in a temporary file at the service where the deceased person resided.
Any correspondence received by the Executive Director Disability, directly from the Ombudsman, will be forwarded on to the funded service.
Assisted Boarding House
When the NSW Ombudsman requests information about a reviewable death, the Assisted Boarding House is required by the due date to:
• Provide a response from the licensee; • Include an assessment of compliance with the Boarding House Act 2012, Boarding Houses Regulation 2013 or Conditions of License; • Mark as confidential and a Reviewable Death Matter; • Forward to the Executive Director Disability Operations; • The Executive Director Disability Operations forwards it to the Deputy Secretary Disability Operations at Performance Improvement.
Copies of all original documents requested by the Ombudsman are to be retained in a temporary file at the service where the deceased person resided.
Any correspondence received by the Executive Director Disability, directly from the Ombudsman, will be forwarded on to the Assisted Boarding House.
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NSW Ombudsman - https://www.ombo.nsw.gov.au/__data/assets/pdf_file/0006/3885/IS_CSD_Reviewable_Disability_Deaths_ FAQ.pdf
Consideration of the CDN
The CDN form and supporting documentation, and incident and briefing notes, provide critical information to enable them to gain an overview of the person's health and support needs, and the circumstances of their death.
Additional records
Additional records may include:
• Service records; • Hospital, GP, community health centres and palliative care team records.
Important
If you receive a request to provide the service records relating to the person who has died, it does not mean there are concerns with your service - only that the NSW Ombudsman needs more information.
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Note
If there is additional information that may be relevant to the NSW Ombudsman's review of the person's death, such as actions staff may have taken that have not been documented, you must bring this to the Ombudsman's attention.
If any concerns are identified through a review, they will be raised with the relevant service or agency. Generally this means that a report is written by the NSW Ombudsman outlining the concerns identified and asking about policy, practice or other initiatives implemented (or planned to be implemented) by the service provider to address the concerns.
In some cases the NSW Ombudsman will meet with the service provider to discuss the issues identified and confirm in writing the discussion and any agreements reached.
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Not completed correctly
For example, when the person has a Mealtime Management Plan because risks have been identified on the Nutrition and Swallowing Checklist and they have been referred to allied health professionals for diagnosis and development of a management plan; however, under ‘swallowing, breathing and choking issues’ the ‘swallowing difficulties’ or ‘help with meals’ boxes are not ticked.
Documentation
Documentation may include:
• Health care plan; • CHAP; • Nutrition and Swallowing Checklist; • Medication reviews; • Mealtime Management Plan; • Eating and Drinking Plans; • Speech Pathologist reports; • Risk profiles; • Palliative care or treatment plans; • End of life care plans;
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• Specific support plans for chronic health conditions, such as Epilepsy, Diabetes, Asthma management, bowel management, etc.; • Mobility plans; • Falls management; • Behaviour management plans; • Restrictive practices.
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Bereavement service
Bereavement counselling is available from many organisations, such as places of worship (e.g. church, synagogue, temple, mosque, etc.), as well as registered psychologists, or services such as Lifeline or Barnardo's.
Talk with the family to find out if they require bereavement counselling and, if so, what type of service they would prefer.
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Employee Assistance Program Services - https://employeeassistance.com.au/our-eap-services/employee- counselling/
Debriefing
Debriefing can be completed by:
• Managers organising an informal discussion amongst the team in a supportive, safe and accepting environment; • A skilled counsellor with a formal debriefing.
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The Bereavement Care Centre - http://www.bereavementcare.com.au/services_adults.htm Managing Grief Better: People with Intellectual Disability - http://www.intellectualdisability.info/mental- health/articles/managing-grief-better-people-with-intellectual-disabilities
Resources
Arrangements can be made for the bereaved person to receive support with communication and bereavement counselling, this may include making a referral to allied health specialists.
A speech pathologist can develop communication aids such as social stories to assist the bereaved person to understand and cope with the death of the person.
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If end of life planning was completed
If end of life planning was completed, confirm with the contact person that they want to implement the plan as it is, or make some changes.
If end of life planning was not completed
If end of life planning was not completed, even if the family is making its own funeral arrangements, it is important to establish if they have any rituals, ceremonies or taboos around the death of a person.
The manager or a delegate can seek information from the family about the following:
• The spiritual and religious beliefs, practices and taboos they wish to observe; • How the person and the family communicate, such as the need for an interpreter, or the acceptability of certain words; • Which member of the family or community is the contact person for problem solving and decision making; • The particular roles the family and community members have after the person dies.
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Culturally appropriate consent
You should ask the person and their family member who in the family is the contact person to discuss issues around death and who provides consent. Record the name(s) and their roles and contact details on the person's records.
Issues of a sensitive nature and practices that are taboo
You should ask the person and their family member to explain what issues around death and dying are sensitive. Record this information on the person's records.
Ceremonies and practices around death and dying
You should ask the person and their family member what they perform. Record these practices in the person's records so support workers are aware.
Family and friends roles and responsibilities
You should ask the person and their family member who will be involved. Record the family and friends roles and responsibilities on the person's records.
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The gathering of the family
The gathering of the family is part of the ceremony to help the spirit leave the person and move away. When the family gathers for this ceremony, ensure there is enough space and privacy for this to occur.
Use of images and naming of the deceased
Saying the person's name or putting up photographs of the person is taboo as some Aboriginal people believe that it calls the spirit back.
Cultural protocol for notifying the designated family member
It may be inappropriate for a non-Aboriginal person, known or unknown to the family, to discuss any issues about the person and the death with the family member directly.
The time of death is very significant for Aboriginal people
Cultural protocol is extremely important at this time. The designated family member must be contacted by the nominated service representative or an Aboriginal Liaison Officer.
Coronial inquests may interfere with practices
Coronial inquests may interfere with the practice of taking the deceased back to their land. Where possible, the family must be informed in advance that it is required by law for everyone receiving a disability service to be the subject of a coronial enquiry.
This will not stop the family's rituals; however, it may delay them.
The way a person dies has different meanings
The way a person dies has different meanings for Aboriginal people. A sudden and unexpected death has a very different meaning to a slow and expected death.
A person accessing a service
When a person is accessing a service, such as a hospital, confirm whether they would like a referral to the Aboriginal Liaison Officer. If so, record this in the person's records and support the person and their family member to access the service.
Funding barriers may occur
Funding barriers may occur with the practices and rituals the family wishes to practice, for example gathering of the family and taking the body back to their land, or the cost of the funeral.
Discuss these issues with the designated family representative and refer the person, or support them to access Burial Assistance funding.
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Loss and grief support
If the family has access to an Aboriginal Liaison Officer they will ensure they are receiving support.
Best practice
Where possible it is best practice to contact Aboriginal Liaison Workers or Community Workers to assist with planning and preparation for the funeral and associated ceremonies.
Refer to 'Other Resources' in the Death Procedures for links to services, information and resources for Aboriginal and Torres Strait Islander peoples.
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Arranging the funeral
If the deceased does not have a family, guardian or advocate, you are responsible for:
• Arranging the funeral; • Advising friends, work associates, day placement, recreation services and service providers of the death of the person and the funeral arrangements.
The local Police
The local Police are responsible for:
• Contacting the NSW Ministry of Health for financial assistance with burials and cremations for a person without means; • Advising the funeral director of the person's death and that it is a destitute burial;
Completing the appropriate forms and forwarding them to the NSW Ministry of Health.
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Asset stock take
When the stock take has been completed the person's assets are placed in a secure storage facility until instructions are given by the NSW Trustee and Guardian or the Executor of the will.
A copy of the asset register is placed in storage with the deceased person's possessions. If the person has a will, the original copy is placed on the person's file and a copy is provided to the solicitor.
Refer to the ADHC Personal Finance Procedures - estate management for instructions.
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QUIZ Q1. If a person has died, the manager must ensure a death certificate is NOT issued. True or false?
Correct Answer: True Q2. What should you do within 1 - 2 hours of the death of a person?
1. Notify ADHC management and next of kin. 2. Refer to the person's End of Life Care Plan. 3. Allow access for the family and significant others to come and visit the house. 4. All of the above.
Correct Answer: All of the above. Q3. A Client Death Notification (CDN) form, must be completed if a person dies in ADHC operated and funded disability services, assisted boarding houses and other ADHC operated services. True or false?
Correct Answer: True Q4. Which of the following should NOT be included on the Briefing Note?
1. The person's previous facility. 2. The person's name, date of birth and address. 3. Length of time at the facility. 4. Communication assistance.
Correct Answer: The person's previous facility. Q5. What should be included as an attachment to the Briefing Note?
1. Incident Report Form. 2. Client Death Notification (CDN) form. 3. Letter provided to the Police and the State Coroner. 4. All of the above.
Correct Answer: All of the above. Q6. When must the Client Death Notification (CDN) form, Briefing Note and relevant attachments be completed after a person has died?
1. Within 1 - 2 hours. 2. Within 24 hours. 3. Within 48 hours. 4. Within 7 days.
Correct Answer: Within 24 hours.
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Q7. After a person has died, when must the NSW Ombudsman, relevant ADHC business areas and relevant external services (e.g. day placement and Medicare) be notified?
1. Within 1 - 2 hours. 2. Within 24 hours. 3. Within 48 hours. 4. Within 7 days.
Correct Answer: Within 48 hours. Q8. How should the ADHC manager notify relevant ADHC business areas (e.g. AESA Committee and CIS) of the death of a person?
1. In writing. 2. Verbally. 3. Through another person in ADHC operated disability support services. 4. Answers 1 and 2.
Correct Answer: Answers 1 and 2. Q9. The Police and State Coroner are the only people required to complete an investigation into a death. True or false?
1. True, the Police and State Coroner are the only people authorised to complete an investigation. 2. False, the NSW Ombudsman also requires ADHC to conduct an internal investigation. Correct Answer: False, the NSW Ombudsman also requires ADHC to conduct an internal investigation. Q10. Which of the following is NOT a role of the NSW Ombudsman?
1. Monitor and review deaths of certain children and people with disability to identify patterns and trends. 2. Create and maintain a register of reviewable deaths in NSW. 3. Register all correspondence on TRIM and link it to the CDN TRIM number. 4. Table a report relating to reviewable deaths to the NSW Parliament every two years.
Correct Answer: Register all correspondence on TRIM and link it to the CDN TRIM number. Q11. You can respond to correspondence received from the NSW Ombudsman, relating to the death of a person who receives an ADHC accommodation support service. True or false?
1. True, you can respond if you knew the person. 2. False, all correspondence is managed by the Performance Improvement Unit.
Correct Answer: False, all correspondence is managed by the Performance Improvement Unit.
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Q12. Which of the following is NOT a responsibility of Performance Improvement?
1. Complete CDN form. 2. Register the correspondence on TRIM and link it to the CDN TRIM number. 3. Forward Incident Report, Briefing Note, CDN and attachments. 4. Send copies of requests for information to FACS Legal.
Correct Answer: Complete CDN form. Q13. Who completes the CDN form and attaches relevant documentation?
1. Line manager. 2. NSW Ombudsman 3. Performance Improvement. 4. Anyone who knew the person.
Correct Answer: Line manager. Q14. Who else may need to be informed, with consent from the person's family, of a person's death?
1. People who lived with the person 2. Friends and support workers at day programs. 3. Community groups that the person is involved with. 4. All of the above.
Correct Answer: All of the above. Q15. Once a person has died, there is no support available to their family. True or false?
1. True, there are no support options available. 2. False, you can make a referral, in consultation with the family, to a bereavement service for bereavement counselling.
Correct Answer: False, you can make a referral, in consultation with the family, to a bereavement service for bereavement counselling. Q16. Who is support available to following the death of a person?
1. Support workers through individual counselling. 2. The person's family through bereavement counselling. 3. Support workers through group debriefing. 4. All of the above.
Correct Answer: All of the above.
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Q17. How can you support a person with disability to deal with grief and loss?
1. Exclude the person so they have time to themselves. 2. Remove reminders of anniversaries. 3. Maximise change. 4. Listen and be present.
Correct Answer: Listen and be present. Q18. Which of the following should be given special consideration following the death of an Aboriginal or Torres Strait Islander person?
1. Consent considerations and protocol. 2. Ceremonies and practices. 3. Notifying the family of the death. 4. All of the above.
Correct Answer: All of the above. Q19. The person's family are always responsible for arranging and paying for the funeral. True or false?
1. True, the family or the person's estate must cover funeral costs. 2. False, the manager can make a referral to the local Police for burial assistance in cases where the family or their estate cannot cover funeral costs.
Correct Answer: False, the manager can make a referral to the local Police for burial assistance in cases where the family or their estate cannot cover funeral costs. Q20. What may the line manager support the person's peers and other support workers to do?
1. Attend the funeral. 2. Provide and organise for communication tools and strategies to be developed to assist other people with disability to understand what to expect at the funeral. 3. Transport other people with disability to and from the funeral. 4. All of the above.
Correct Answer: All of the above.
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Q21. If a person is away from home (temporarily absent) and dies whilst they are in hospital, who reports the death to the Police and Coroner and what is your role?
1. Do nothing, it's up to the hospital to report the death to the Police and coroner. 2. Provide the hospital with the Factsheet: Information for health care and aged care facilities about the death of a person with disability, and ensure they notify the Police and Coroner by completing and sending the Temporarily Absent letters to the Police and Coroner. 3. Send the Temporarily Absent letter templates to the Hospital.
Correct Answer: Provide the hospital with the Factsheet: Information for health care and aged care facilities about the death of a person with disability, and ensure they notify the Police and Coroner by completing and sending the Temporarily Absent letters to the Police and Coroner. Q22. When completing the CDN form, do you put information directly into the form or refer to other documents?
1. Write down where the information can be found. 2. Do not complete the questions, the information can be found in other documents. 3. Write all the required information into the CDN form.
Correct Answer: Write all the required information into the CDN form. Q23. What do you need to do before notifying next of kin when an Aboriginal or Torres Strait Islander person dies?
1. Refer to the person' s end of life plan or ask the contact person which family member was nominated as the contact person to discuss issues around death, dying and who should give notification. 2. Turn up at the family house unannounced and tell the person who answers the door. 3. Ask the Police to tell the family.
Correct Answer: Refer to the person's end of life plan or ask the contact person which family member was nominated as the contact person to discuss issues around death, dying and who should give notification.
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ATTACHMENTS 1. ADHC Death Procedures.pdf 2. Category 1 Incident - Executive Briefing Form 3. Client Death Notification (CDN) Form 4. Death Procedures 5. Language Services Guidelines 6. NSW Ombudsman Reviewable Deaths Fact Sheet 7. NSW Ombudsman.pdf 8. NSW Police notification of death letter 9. NSW Police notification of death letter (temporarily absent at the time of death) 10. NSW State Coroner notification of death letter 11. NSW State Coroner notification of death letter (temporarily absent at the time of death) (1) 12. Operational Guidelines for the review of the death of People with Disability 13. Other Resources 14. Supporting People with Disabilities Coping with Grief and Loss 15. Work Health and Safety Act 2011
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Document name Death Procedures
Policy Health and Wellbeing Policy
Version number 1.1
Approval date January 2016
Policy manual Health and Wellbeing Policy and Practice Manual, Volume 2
Approved by Deputy Secretary, ADHC
Summary The Death Procedures provide instructions for support workers and managers to follow when a person dies.
Replaces document Client Death Policy and Procedures 2012
Authoring unit Contemporary Residential Options Directorate
Applies to People receiving support in ADHC operated and funded non-government accommodation support services, centre-based respite, drop-in support and assisted boarding houses.
Review date 2017
Version control The first and final version of a document is version 1.0. The subsequent final version of the first revision of a document becomes version 1.1. Each subsequent revision of the final document increases by 0.1, for example version 1.2, version 1.3 etc.
Revision history
Version Amendment date Amendment notes
V1.0 January 2016 Replaces the Client Death Policy and Procedures 2012
V1.1 November 2016 Amended to update reporting of Category 1 incidents to Performance Improvement
Death Procedures, V1.1, November 2016 2
Table of contents 1 Death of a person ...... 5 1.1 Legal and Legislative Framework ...... 5 1.2 Application of Procedures: Table A ...... 10 2 Unresponsive person ...... 13 2.1 Apply First Aid and call an Ambulance ...... 13 2.2 Notify the next Line Manager ...... 13 2.3 Attendance of Ambulance ...... 13 2.4 Admission to Hospital ...... 14 3 Deceased person ...... 14 4 Response within 1 to 2 hours of death ...... 14 4.1 Notify management ...... 14 4.2 Notify next of kin or guardian ...... 15 4.3 Report the person’s death to NSW Police ...... 16 4.4 Letters for NSW Police and State Coroner ...... 16 4.5 Report the death to WorkCover ...... 17 4.6 Transportation of the deceased ...... 18 5 Response within 24 to 48 hours of death ...... 18 5.1 ADHC operated accommodation support services ...... 18 5.2 Other ADHC operated services ...... 19 5.3 ADHC funded non-government disability support services ...... 19 5.4 Briefing Note ...... 19 5.5 Attachments to the Briefing Note ...... 20 6 Response 48 hours after death ...... 21 6.1 ADHC operated accommodation support services ...... 21 6.2 Reporting to the NSW Ombudsman ...... 21 6.3 Notifying internal FACS Services...... 22 6.4 Notifying external services ...... 22 6.5 Internal review of the death ...... 22 7 Responding to the NSW Ombudsman ...... 23 7.1 ADHC operated accommodation support services ...... 23 7.2 ADHC funded non-government disability support services and Assisted Boarding Houses ...... 24 7.3 FACS Performance Improvement Unit ...... 25 8 Bereavement support ...... 25
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8.1 Informing other people ...... 25 8.2 Supporting the family ...... 25 8.3 Supporting support workers ...... 26 8.4 Supporting other people with disability ...... 26 9 Post death requirements ...... 27 9.1 Cultural and linguistic diversity ...... 27 9.2 Aboriginal and Torres Strait Islander People ...... 28 10 Funeral arrangements ...... 29 11 Estate management ...... 30 12 The person’s bedroom and assets ...... 30 13 Explanation of terms ...... 32 14 Policy and Practice Unit contact details ...... 36 15 Index of flowcharts ...... 37
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1 Death of a person
The ADHC Death Procedures (the Procedures) embody the principles of legal and human rights found in the New South Wales Disability Service Standards (the Standards), the commitment to deliver culturally responsive services to Aboriginal and Torres Strait Islander people under the Aboriginal Policy Statement and the person centred guiding principles of the ADHC Health and Wellbeing Policy. The following section provides direction to support workers in the event of a person becoming unresponsive, or if an unresponsive or deceased person is found. The Procedures are mandatory for ADHC operated accommodation support services, centre-based respite, drop-in support, Large Residential Centres and Specialist Supported Living, and must be followed in sequence. Flowcharts are provided at the end of these Procedures to assist support workers and managers, and reflect the contents of the following sections. Some of the response and reporting requirements are binding under the law and apply to ADHC funded non-government accommodation and other support services, including assisted boarding house1 (Section 1.1). ADHC funded non- government service providers should familiarise themselves with the sections that apply to them. Assisted Boarding Houses are required to follow these Procedures as specified in the Assisted Boarding House Authorisation and Monitoring Manual2.
1.1 Legal and Legislative Framework
The key relevant laws in relation to these procedures are set out below. Table A summarises the responsibilities of service providers under the legislation. Mandatory reporting requirements, of the death or suspected death of a person with disability, to the NSW Police and State Coroner are covered under the following sections of the Coroners Act 2009. They apply to both ADHC operated and ADHC funded non-government disability support services and Assisted Boarding Houses. The legislative requirements are detailed in the following tables.
1 Under the Boarding Houses Act 2012, all boarding houses that have two or more ‘persons with additional needs’ must be authorised and licensed by FACS, and are known as assisted boarding houses.
2 http://www.adhc.nsw.gov.au/publications/policies/policies_a-z/?result_237652_result_page=A
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Coroners Act 2009 Section 24 Jurisdiction concerning deaths of children and disabled persons Section 24(1) gives jurisdiction for a senior coroner to hold an inquest into the death or suspected death of any person with disability who at the time of their death were receiving support from an accommodation support service that is funded non-government or operated by ADHC under the Disability Inclusion Act 2014 or an assisted boarding house under Part 4 of the Boarding Houses Act 2012. This includes a person who, at the time of death, was temporarily absent from an ADHC operated or funded non-government accommodation support service, centre-based respite or an assisted boarding house, for example, in hospital. Section 35 Obligation to report death or suspected death Requires that a death or suspected death of a person under Section 24(1) must be reported to a police officer, a coroner or an assistant coroner as soon a possible after becoming aware of the death. Section 36 State Coroner to inform the NSW Ombudsman about certain child or disability deaths Requires the State Coroner to provide to the NSW Ombudsman all relevant material regarding the death or suspected death of any person under Section 24(1). Section 38 Medical practitioner must not certify cause of death if death is reportable An attending medical practitioner is not permitted to issue death certificates for people who are under the care of an accommodation support service as per Section 24(1), or who are temporarily absent from an accommodation support service at their time of death, such as a person who dies in hospital.
Mandatory reporting requirements of a death or suspected death of a person with disability to the NSW Ombudsman are covered under the following sections of the Community Services (Complaints, Reviews and Monitoring) Act 1993 and apply to both ADHC operated and ADHC funded non-government support services as well as assisted boarding houses.
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Community Services (Complaints, Reviews and Monitoring) Act 1993 Section 35 Application of Part 1) This Part applies in respect of the deaths of the following persons (in this part referred to as “reviewable deaths”): a. a child in care b. & c. repealed d. a child whose death is or may be due to abuse or neglect or that occurs in suspicious circumstances, e. a child who, at the time of the child’s death, was an inmate of a children’s detention centre, a correctional centre or a lock- up (or was temporarily absent from such a place), f. a person (whether or not a child) who, at the time of the person’s death was living in, or temporarily absent from, residential care provided by a service provider or an assisted boarding house (in this Part referred to as a “person in residential care”), g. a person (other than a child in care) who is in a target group within the meaning of the Disability Inclusion Act 2014 who receives from a service provider assistance (of a kind prescribed by the regulations) to enable the person to live independently in the community. 2) In this Part “Assisted boarding house” includes premises that were a residential centre for handicapped persons (within the meaning of this Act before it was amended by the Boarding House Act 2012) at the time of the death concerned. "Child" means a person under the age of 18 years. Section 6 Service provider means: a. the Department of Family and Community Services (FACS) b. an implementation company under the National Disability Insurance Scheme (NSW Enabling Act 2013) while the company is a public sector agency of the State under that Act or c. a person or organisation funded by the Minister for Family and Community Services, the Minister for Ageing or the Minister for Disability Services to provide a service, or d. a person or organisation authorised or licensed by the Minister for Family and Community Services, the Minister for Ageing or the Minister for Disability Services to provide a service, or e. the Home Care Service of NSW or a person or organisation funded by the Home Care service to provide a service or f. a person or organisation that is covered by an arrangement
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Community Services (Complaints, Reviews and Monitoring) Act 1993 made after 7 April 1994 (the date of commencement of this section) between a Minister of the State of New South Wales and a State or Commonwealth Minister, under which arrangement that State or Commonwealth Minister agrees to the person or organisation being a service provider for the purposes of this Act3, or g. an authorised carer or designated agency within the meaning of the Children and Young Persons (Care and Protection) Act 1998, or h. the proprietor or occupier of premises that consist of an assisted boarding house. Section 37 The Deputy Secretary of ADHC must provide the Ombudsman with (2) & (4) copies of any notification received by the Deputy Secretary relating to a reviewable death not later than 30 days after receiving the notification. The Deputy Secretary of ADHC means the person employed by FACS as the Deputy Secretary of ADHC, or if there is no such person, the Secretary of the Department.
All staff have a legal duty to provide assistance to an unresponsive person under Section 44 of the Crimes Act 1900.
Crimes Act 1900 Section 44 Failure of persons to provide necessities of life 1) A person a. Who is under a legal duty to provide another person with the necessities of life, and b. Who, without reasonable excuse, intentionally or recklessly fails to provide that person with the necessities of life, is guilty of an offence if the failure causes a danger of death or causes serious injury, or the likelihood of serious injury to that person. Necessities of life refer to those things necessary to preserve life, such as food, shelter, medical attention and protection from harm.
Mandatory reporting requirements of a death or suspected death of a person with disability to the Deputy Secretary (formerly the Director General) are covered under the following sections of the Boarding House Act 2012.
3 Note: There is a Ministerial arrangement made under paragraph (f) which means that service providers includes those who provide services to recipients in the NDIS trial site).
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Boarding House Act 2012 Section 83 Notification of deaths, sexual assaults and other incidents involving residents of authorised boarding houses 1) The manager of an authorised boarding house must, as soon as is reasonably possible after becoming aware of any of the following incidents, report the incident to the Deputy Secretary: a. the death of a resident of the assisted boarding house, b. (not relevant to these Procedures) c. (not relevant to these Procedures) d. (not relevant to these Procedures) 2) The manager must also report the death (or the sexual assault or the making of an allegation of sexual assault) of a resident of the authorised boarding house to a police officer as soon as is reasonably practicable after becoming aware of the incident concerned. 3) A manager of an assisted boarding house who contravenes this section is guilty of an offence.
Mandatory reporting requirements of any Police officer attending a death or suspected death must be reported to FACS are covered under the following sections of the Boarding Houses Regulation 2013.
Boarding Houses Regulation 2013 Regulation Reporting police attendances 27 1) The manager of an authorised boarding house must report to the Deputy Secretary the attendance of any police officer at the boarding house as soon as is reasonably practicable after the attendance if the reason for the attendance was to investigate an incident involving an additional needs resident.
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1.2 Application of Procedures: Table A
These procedures are mandatory for ADHC operated accommodation support services including centre-based respite services and other support services, unless otherwise stated. Some sections are mandatory for ADHC funded non-government support services and assisted boarding houses. They must be completed as part of the responding and reporting requirements under the service’s administrative processes.
AHDC funded Assisted boarding Section non-government house 1 Death of a person Mandatory Mandatory 1.1 Legal and legislative framework Mandatory Mandatory 2 Unresponsive person Mandatory Mandatory 2.1 Apply first aid and call an Mandatory Mandatory ambulance 2.2 Notify the next line manager Mandatory Mandatory 2.3 Attendance of ambulance Mandatory Mandatory 2.4 Admission to hospital Mandatory Mandatory 3 Deceased person Mandatory Mandatory 4 Response within 1 to 2 hours of Mandatory and adapt Mandatory and adapt the death to align with service’s to align with service’s processes processes 4.1 Notify management Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes 4.2 Notify next of kin or guardian Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes 4.3 Report the person’s death to Mandatory Mandatory NSW Police 4.4 Letters for NSW Police and Mandatory and adapt Mandatory and adapt State Coroner to align with service’s to align with service’s processes processes 4.5 Report death to Work Cover Mandatory Mandatory 4.6 Transportation of the deceased Mandatory Mandatory 5 Response within 24 to 48 hours Mandatory Mandatory 5.1 ADHC operated disability NA NA services 5.2 Other ADHC operated services NA NA
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AHDC funded Assisted boarding Section non-government house 5.3 ADHC funded non-government Mandatory NA services 5.4 Assisted boarding house NA Mandatory 5.5 Briefing note Mandatory NA 5.6 Attachments to the Briefing Mandatory Mandatory Note 5.6.1 Incident report form Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes 5.6.2 Client death notification form Mandatory Mandatory 5.6.3 Letter provided to State Coroner Mandatory Mandatory and NSW Police 5.6.4 Documentation Mandatory Mandatory 6 Response after 48 hours of Partial requirement Partial requirement death 6.1 ADHC operated NA NA accommodation services 6.2 Reporting to the NSW Mandatory Mandatory Ombudsman 6.3 Notifying internal FACS If applicable If applicable services 6.4 Notifying external services Mandatory Mandatory 6.5 Internal review of the death Mandatory and adapt Adapt to align with to align with service’s service’s processes processes 7 Responding to the NSW Mandatory Mandatory Ombudsman 7.1 ADHC operated disability NA NA services 7.2 ADHC funded non-government Mandatory Mandatory disability services and assisted boarding house 7.3 Strategic Change ADHC Mandatory Mandatory 8 Bereavement support Mandatory and adapt If applicable to align with service’s processes 8.1 Informing other people Mandatory If applicable 8.2 Supporting the family Mandatory If applicable 8.3 Supporting support workers Mandatory and adapt Adapt to align with to align with service’s service’s processes
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AHDC funded Assisted boarding Section non-government house processes 8.4 Supporting other people with Mandatory and adapt Mandatory and adapt disability to align with service’s to align with service’s processes processes 9 Post death requirements Mandatory Mandatory 9.1 Cultural and linguistic diversity Mandatory If applicable 9.2 Aboriginal and Torres Strait Mandatory Mandatory and adapt Islander people to align with service’s processes 9.2.1 Consent consideration and Mandatory Mandatory and adapt protocol to align with service’s processes 9.2.2 Ceremonies and practices Mandatory Mandatory and adapt to align with service’s processes 9.2.3 Notifying the family of the death Mandatory Mandatory 9.2.4 Support Mandatory Mandatory 10 Funeral arrangements Mandatory Adapt to align with service’s processes 11 Estate management Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes 12 The person’s bedroom and Mandatory and adapt Mandatory and adapt assets to align with service’s to align with service’s processes processes 13 Explanation of terms Observe Observe 14 Policy and practice contact If required If required details Flowcharts 1-3 Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes
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2 Unresponsive person
When a person is found to be unresponsive or unusually unwell, the following steps must be followed.
2.1 Apply First Aid and call an Ambulance
If the person is not breathing, the support worker holding a current first aid qualification starts first aid and dials 000 to request an ambulance. If two people are on shift, one calls the ambulance while the other gives first aid. Continue first aid until the ambulance arrives. If the person has a current medically authorised Resuscitation Plan or Advance Care Directive, the caller must provide that advice when they dial 000.
2.1.1 Ambulance paramedics implementing Advanced Care Directives and authorised Resuscitation Plans The current NSW Ambulance protocols: • Do not support ambulance paramedics to follow instructions in a patient’s advanced care directive. • Allow ambulance paramedics to act on authorised Resuscitation Plans. Resuscitation Plans are plans developed in a hospital by an attending medical officer in consultation with the person or their person responsible. Refer to http://healthlaw.planningaheadtools.com.au/advance-care-plans-and- the-law/.
2.2 Notify the next Line Manager
A support worker at the scene notifies the relevant manager, the direct line manager, senior manager or on call manager (for after hours) of the situation.
2.3 Attendance of Ambulance
When the ambulance arrives, first aid responsibility is handed over to the attending ambulance officers. If the person has an Advance Care Directive and/or Resuscitation Plan, this is given to the ambulance officers as soon as they arrive to inform them of the person’s wishes regarding resuscitation. For further information about Advance Care Directives and Resuscitation Plans, refer to the End of Life Care Planning Guidelines in Volume 2 of the Health and Wellbeing Policy and Practice Manual and/or http://healthlaw.planningaheadtools.com.au/advance-care-plans-and-the-law/ .
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2.4 Admission to Hospital
If the person is admitted to hospital, notify the relevant manager, and the person’s family. Provide the hospital with the person’s Hospital Support Plan. Any disability support required by the person is negotiated between the hospital and ADHC, according to the Hospitalisation Guidelines and the person’s Hospital Support Plan (in Volume 2 of the Health and Wellbeing Policy and Practice Manual). If the person has any type of documentation about end of life care decisions, support is provided to ensure that the person’s wishes concerning end of life care are followed.
3 Deceased person
The person’s death is reported to the local police, and the caller advises the NSW Police that the death is reportable under the Coroners Act 2009 s24. If a person dies in their accommodation service the death is declared by the attending ambulance officers or a medical practitioner, if one is present. As far as possible the support worker ensures that the scene is unaltered. If the person dies after being admitted to a health facility such as a hospital or aged care facility, the accommodation support service manager must ensure that the doctor in charge is advised not to issue a death certificate (see Fact Sheet, Other resources). A death certificate can only be issued by the State Coroner.
4 Response within 1 to 2 hours of death
Refer to section 15 of these Procedures (page 36) for a flow chart of the immediate actions and response required within 1 to 2 hours of a person’s death.
4.1 Notify management
The death of the person must be reported to the manager or on call manager immediately. All deaths must be reported, regardless of the circumstances of the death, and including a person who died in a hospital or aged care facility. The Manager, Accommodation and Respite, or on-call manager, reports the death to the Director Disability Operations who notifies the relevant Executive Director Disability Operations or equivalent position. Senior management considers the circumstances and provides advice and support to the appropriate manager to complete the next steps, including
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notifying next of kin or guardian, the NSW Police and developing the briefing note to the Executive Director Disability Operations or equivalent (see Section 5.5). The Manager, Accommodation and Respite is the central point of contact and delegates areas of responsibility to the Coordinator Accommodation and Respite, and Team Leader as appropriate.
4.2 Notify next of kin or guardian
If the deceased person’s next of kin or guardian is not present at the time of death, the manager is responsible for notifying them of the death. While not always possible, notification is preferably done in person. Where the notification of the next of kin is given in person, the manager rings before coming over to see them, informs them a situation has occurred and they need to come and speak with them, and asks and whether they can arrange a support person of their choosing to be present whilst they have this discussion. Where the notification is done over the phone, the manager rings prior to inform the person that a situation has occurred and whether they could arrange a support person of their choosing to be present whilst they have this discussion. When an Aboriginal and Torres Strait Islander person dies, it is important to identify the senior member of the family to advise on matters surrounding the death, as it is a breach of cultural protocol to inform the family directly. This may also apply in other cultures and it is important to ask the family if there are any cultural protocols to be observed (see End of Life Care Planning Guidelines – Section 1.4 Cultural and Linguistic Diversity for more information) At the time of notification, the following information is provided by the manager: • when and where the person died (provide information about the circumstances of the death to assist the family to understand what has occurred in the case of an unexpected death) • that the death will be reported to NSW Police who will inform the State Coroner • that the death will be reported to the NSW Ombudsman. Refer to end of life care planning documentation the person has in place stating their preferences or wishes in the event of death. If the person does not have an end of life care plan, the manager will ascertain with the next of kin or guardian: • if they require an interpreter service • the need to observe any cultural or religious practices or taboos • whether the family or others wish to view the deceased person • a suitable time to view the deceased person before transportation to the State Coroner. Alternatively, viewing times may be arranged with the State Coroner or funeral director.
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The person’s family and friends may choose to visit the house to view the person’s bedroom and belongings. To facilitate this, ensure the person’s bedroom and belongings remain how they were left.
4.3 Report the person’s death to NSW Police
The manager ensures that the person’s death is reported to the local NSW Police, and they understand that the death is reportable under the Coroners Act 2009 s24. The manager is to: • ensure that the name, rank and station of the attending NSW Police officer is recorded and retained by the service • organise support for another person with disability if the NSW Police indicate they wish to interview this person. Support includes an advocate or person of their choice, and if necessary, legal representation • confirm who will identify the person to the NSW Police, that is family, a friend, the manager, or an ADHC employee who knows the person. If the NSW Police wish to interview an ADHC support worker, contact ADHC FACS Legal for assistance, or if outside business hours, the on call manager. Note: The manager of an Assisted Boarding House is required under the Boarding House Act 2012 to inform FACS as soon as is reasonably possible (preferably within 24 hours), about the death of a person from an Assisted Boarding House, as outlined in the Assisted Boarding House Authorisation and Monitoring Manual.
4.4 Letters for NSW Police and State Coroner
Unit managers are to ensure that standard letters are sent notifying the NSW Police and the State Coroner of the person’s death. A different letter is required if the person was temporarily absent from their residence at their time of death (see Tools and templates). The manager is to: • retain copies of the completed letters • hand over the original letters for the State Coroner and NSW Police to the attending Police Officer and request that they be lodged with the State Coroner when the deceased is transported to the morgue. When a person is temporarily absent at their time of death, for example, in a hospital, or aged care facility or staying with family or friends, the manager completes the letters. The manager immediately informs the relevant person, where the deceased was staying at the time of death, that the death is reportable. The manager can then complete the letters for that person to give to the NSW Police when the deceased is transported to the morgue.
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4.5 Report the death to WorkCover
The Work Health and Safety Act 2011 (WH&S Act 2011) require the regulator (WorkCover) to be notified immediately of deaths and serious incidents which occur in the workplace. Serious incidents can be serious illnesses or serious injury of a person, dangerous incidents (an incident that exposes a worker or any other person to a serious risk to health or safety) or the death of a person arising out of work carried out by a business undertaking or workplace. This includes all deaths or serious injuries to people living in an ADHC operated or funded non- government support service, or in an Assisted Boarding House. The WH&S Act 2011 also requires the site of the incident to be preserved until an inspector arrives or directs otherwise (subject to some exceptions). If a person dies in an ADHC operated or funded non-government support service, or an Assisted Boarding House, the manager responding to the death must report the death to WorkCover at the same time as they report the death to the NSW Police. The WorkCover officer responding to the phone call will ask the manager the following of questions about the incident: • a description of what happened • when it happened • where it happened • who was involved • the legal and trading name of the ADHC operated or funded non- government service, or Assisted Boarding House • whether the NSW Police have been contacted and are attending the scene • whether the body of the deceased will be transported to the State Coroner • the name of the manager notifying WorkCover. If the manager is unable to provide all of the information requested at the time of notification, the remaining information will be collected by WorkCover at a later time. After the phone call, the manager is to document: • the time they notified WorkCover • the name of the WorkCover officer they spoke to • advice or directions provided by the WorkCover officer during the phone call. This information will be required for a briefing note to the Executive Director Disability Operations or equivalent.
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The manager is responsible for ensuring that the site where the incident occurred is left undisturbed, so far as possible. An incident site may be disturbed however to: • assist an injured person • remove a deceased person • facilitate a Police investigation • make the site safe or to minimise the risk of a further ‘notifiable incident’ • follow direction given either in person or by telephone by a WorkCover officer. Refer to flowchart 1 of this document and to the WorkCover Fact Sheet – Incident Notification (see Tools and templates) or for further advice on notifiable incidents contact NSW WorkCover on 131050.
4.6 Transportation of the deceased
The NSW Police are responsible for placement of an identification tag and arranging transportation of the deceased person to the State Coroner.
5 Response within 24 to 48 hours of death
Refer to section 15 of these Procedures (page 37) for a flow chart of the following actions required within 48 hours of a person’s death (flow chart 2).
5.1 ADHC operated accommodation support services
In all ADHC operated accommodation support and centre-based respite services, the person’s death is classified as either expected or unexpected, depending on the circumstances (see Section 13). In both cases the manager completes a Client Information System (CIS) Incident Report form either electronic or paper version (see FACS Incident Reporting and Management Policy and Guidelines for people accessing Ageing and Disability Direct Services, November 2014) and enters it in CIS. • Unexpected Death – Category 1 Report • Expected Death – Category 2 Report. Where the death was unexpected, ADHC staff are to follow these procedures and prepare the briefing note and attachments to the Executive Director Disability Operations or equivalent (see section 5.5).
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5.2 Other ADHC operated services
When a person dies unexpectedly in an ADHC operated disability support service, other than an accommodation support service or centre-based respite, a Category 1 Incident – Executive Briefing Form (see Tools and templates) is completed and scanned and emailed to Deputy Secretary Disability Operations at [email protected] and [email protected] Refer to the FACS Incident Reporting and Management Policy and Guidelines for people accessing Ageing and Disability Direct Services, November 2014 for assistance when completing the Category 1 Incident – Executive Briefing Form for an unexpected death. In all ADHC operated accommodation support and centre-based respite services, whether the death is expected or unexpected, the manager prepares and forwards a Briefing Note and attachments to the Executive Director Disability Operations or equivalent.
5.3 ADHC funded non-government disability support services
Within 24-48 hours of the death of the person, ADHC funded non-government support services are to provide verbal advice of the death to the Executive Director Disability Operations or equivalent in their District. ADHC funded non-government support services are required to complete a briefing note and attachments (see below sections 5.5 and 5.6.1-4). The documents are scanned and emailed to Deputy Secretary Disability Operations at [email protected] Assisted Boarding Houses ADHC staff or staff of ADHC funded non-government support services are to advise the manager of an Assisted Boarding House that, on the death of a person living in their service, the Client Death Notification form contained in the Assisted Boarding House Practice Guide is to be completed and emailed to Deputy Secretary Disability Operations at [email protected] as soon as is reasonably possible, preferably within 24 hours.
5.4 Briefing Note
The content of the Briefing Note to the Executive Director Disability Operations or equivalent and for funded non-government disability services to the Deputy Secretary should include the following information: • the person’s name, date of birth, address • date of death
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• whether the death was expected or unexpected • if an expected death, the person’s diagnosis (if known) • length of time at facility • contact details of ‘next of kin’ or guardian • record of contact with ‘next of kin’ or guardian • record of contact with the NSW Police and/or State Coroner • record of contact with WorkCover and the advice provided • communication assistance • general medical issues • medication • identified disabilities • mobility • height and weight • events surrounding an unexpected death and police advice.
5.5 Attachments to the Briefing Note
5.5.1 Incident Report Form The Incident Report Form is completed by a support worker and the manager who was notified at the time of the person’s death. Information for completing the Incident Report Form can be found in the FACS Incident Reporting and Management Policy and Guidelines for people accessing Ageing and Disability Direct Services November 2014. The Incident Report Form is completed in either electronic or paper format. ADHC funded non-government services will use their services’ incident report form.
5.5.2 Client Death Notification Form (CDN) The CDN form is available on the ADHC intranet, and on the Service Provider Portal for ADHC funded non-government accommodation support services and assisted boarding houses.
5.5.3 Letter provided to the State Coroner and NSW Police ADHC operated and funded non-government accommodation support services are to attach copies of the letters written to the NSW Police and the State Coroner (see Tools and templates) to the briefing note.
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5.5.4 Documentation Copies of specific documentation relating to the deceased person are required in their most current format. This documentation includes the person’s: • Nutrition and Swallowing Risk Checklist • Mealtime Management Plan, if applicable • Enteral Nutrition Plan, if applicable • My Health and Wellbeing Plan or any other health care plan • Lifestyle Plan • plans for chronic and other health conditions for example epilepsy, asthma, diabetes, bowel care, and respiratory management • My Safety Profile and My Safety Plan • Behaviour Support Plan, if applicable • Palliative Care Plan or other treatment plan, if applicable • any document that has been developed by the person, with the person or on behalf of the person that contains end of life care decisions, including Advance Care Directives or Resuscitation Plan, if applicable.
6 Response 48 hours after death
6.1 ADHC operated accommodation support services
The Executive Director Disability Operations or equivalent, endorses the briefing note, incident report and attachments and forwards the documents to the Deputy Secretary Disability Operations at [email protected] . If the death is unexpected, a copy of the briefing note, incident report and attachments is sent to FACS Legal for information. The Performance Improvement Unit forwards all briefing notes and attachments to the NSW Ombudsman to notify of the person’s death.
6.2 Reporting to the NSW Ombudsman
When a person dies in an accommodation support service (funded non- government or operated by ADHC), centre-based respite service, or an Assisted Boarding House, it is mandatory to report the death to the NSW Ombudsman through the Performance Improvement Unit using the CDN form. Section 7 of these Procedures provides guidance for responding to the NSW Ombudsman following the death of a person from a disability service.
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6.3 Notifying internal FACS Services
The manager informs relevant FACS business areas of the death of the person. This can either be done verbally or in writing. Business areas and systems that may require notification include: • Aids and Equipment in Supported Accommodation (AESA) Committee to return items purchased through this scheme to the AESA aids and equipment pool • Business Services to cancel residency charges • internal therapy appointments • CIS to register the date of death of the person.
6.4 Notifying external services
The Manager informs relevant external services of the death of the person. This can either be done verbally or in writing, depending on the requirements of the external service. External services that require notification include: • day / work program • financial Institutions and managers • NSW Trustee and Guardian (formerly known as the Office of the Protective Commissioner) for people under banker arrangements, or for people under financial guardianship • dentist • doctor • allied health professionals • health fund - Medicare • clubs/groups and • subscriptions. The death certificate may be required as evidence of the person’s death when notifying external services.
6.5 Internal review of the death
The NSW Ombudsman requires ADHC to conduct an internal review following the death of a person. Districts must review all deaths whether the person was at their usual residence or temporarily absent, for example in hospital, visiting family, on holidays or in the community. All reviews must be conducted in
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accordance with the ADHC Operational Guidelines for the Review of the Death of People with Disability. The review process is documented and the outcome, including recommendations, are recorded as required in the Operational Guidelines for the Review of the Death of People with Disability and submitted to the relevant Executive Director Disability Operations and to Deputy Secretary, Disability Operations.
7 Responding to the NSW Ombudsman
The NSW Ombudsman is concerned with systemic issues and how deaths might be prevented. The Ombudsman specifically: • monitors and reviews deaths of people with disabilities and certain children to identify patterns and trends • analyses the circumstances of reviewable deaths, and makes recommendations for reviewing policies and practices relating to the support and safety of children, and people with disabilities • creates and maintains a register of reviewable deaths in NSW • undertakes research and projects focusing on strategies to reduce or remove risk factors associated with deaths that are preventable • tables a report relating to reviewable deaths to the NSW Parliament every two years. The protocol for responding to a complaint or request for information from the NSW Ombudsman depends on whether the subject is an ADHC operated or funded non-government disability service, or an assisted boarding house. Flow chart 3 and the following sections outline the responsibilities of all disability service providers when responding to the NSW Ombudsman (section 15, page 38). Note that in addition to requests for information from the NSW Ombudsman, ADHC operated and funded non-government services may also receive requests for information from the State Coroner. Requests from the State Coroner are referred to FACS Legal for action at [email protected].
7.1 ADHC operated accommodation support services
If the Ombudsman’s request is about an ADHC operated accommodation support service it will be managed by the Performance Improvement Unit. The Performance Improvement Unit will forward the documents to the relevant Executive Director Disability Operations , with a copy sent to FACS Legal. The Performance Improvement Unit will liaise with the relevant Executive Director Disability Operations and arrange for the request to be investigated, and can
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seek advice from FACS Legal about the information the District is legally required to provide. The response is submitted to the Deputy Secretary, Disability Operations. Copies of all original documents are to be retained in a temporary file at the service where the deceased person resided.
7.2 ADHC funded non-government disability support services and Assisted Boarding Houses
When the NSW Ombudsman requests information about a reviewable death, the ADHC funded non-government disability support service or Assisted Boarding House is required to provide a response to the Executive Director Disability Operations or equivalent by the due date. If the Executive Director Disability Operations or equivalent receives correspondence directly from the NSW Ombudsman about an ADHC funded non-government disability support service or Assisted Boarding House, the Executive Director Disability Operations, an equivalent or a delegated person, refers the correspondence on to the funded service or the Assisted Boarding House. The funded non-government disability support service or Assisted Boarding House provides a response, which must be endorsed by a senior manager of the funded service, or the licensee of the Assisted Boarding House, and sends it to the Executive Director Disability Operations or equivalent. The appropriate District manager drafts the following documents to accompany the response to the Ombudsman: • an assessment of compliance with ADHC policy, conditions of funding agreement or in the case of Assisted Boarding House, the Boarding House Act 2012, Boarding Houses Regulation 2013 or Conditions of License (legal advice can be sought from FACS Legal to help with this assessment) • the original response provided by the funded service or the assisted boarding house. Copies of these two documents are marked confidential, flagged as a Reviewable Death Matter and forwarded to the Executive Director Disability Operations or equivalent position. In the case of an Assisted Boarding House, it may also be appropriate to provide a copy to the Executive Director who has oversight of Boarding House Compliance Officers. The Executive Director Disability Operations or equivalent position should then forward these documents to the Deputy Secretary Disability Operations at [email protected]. Copies of all original documents requested by the Ombudsman are to be retained in a temporary file at the service where the deceased person resided.
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7.3 Performance Improvement Unit
All correspondence received from the NSW Ombudsman relating to the death of a person who receives an ADHC accommodation support service or centre- based respite service is managed by the Performance Improvement Unit [email protected]. The Performance Improvement Unit registers the correspondence on TRIM and links it to the CDN TRIM number. The Performance Improvement Unit forwards all correspondence from the NSW Ombudsman to the Executive Director Disability Operations or equivalent of the District where the deceased person resided. To ensure that FACS Legal is aware of ongoing inquiries, the Performance Improvement Unit also sends copies of requests for information from the Ombudsman, and responses from ADHC to the Ombudsman’s inquiries, to FACS Legal ([email protected]).
8 Bereavement support
Grief is a normal response to loss and can occur at any time, even before the person dies. People experiencing grief are often supported by family and friends and sometimes external support is needed.
8.1 Informing other people
The line manager should ask the family’s consent to inform others about the person’s death and how they would like it done. Others might include: • people who lived with the person • friends and support workers at day programs • work colleagues at the person’s place of employment • community groups that the person is involved with.
8.2 Supporting the family
In consultation with the family, an employee of an operated or funded non- government can make a referral to the Beareavment Care Centre or a bereavement care service that is available in the local area for bereavement counselling services (see Other resources). Bereavement counselling is available from many organisations, such as places of worship e.g. church, synagogue, temple etc., registered psychologists, or services such as Lifeline or Barnardo’s etc. Talk with the family to find out if they require bereavement counselling and if so, what type of service they would prefer.
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Consideration should be given to families and others in the event of the death of their loved ones, including: • responding in a prompt and dignified manner • respecting and being sensitive to cultural and religious beliefs and practices of the person and family • ensuring the deceased person’s bedroom is left intact so that the family, friends and support workers have the opportunity to visit the bedroom • assisting with funeral preparations where possible (see Section 10) • maintaining contact with the family after the funeral, this is especially important if family were actively involved in activities at the disability service, and had formed relationships with other people with disability, their families and support workers • providing relevant information to the family where action has been taken to improve service as a result of the death of their family member.
8.3 Supporting support workers
The loss of a person also affects support workers. They often have a difficult time dealing with their loss, and it is the managers’ responsibility to support them through this process. An individual counselling or group debriefing may be beneficial, as well as giving support workers the opportunity to talk about how they are feeling immediately after the event and over time. Debriefing can be done by managers organising an informal discussion amongst the team in a supportive, safe and accepting environment, or by formal debriefing with a skilled counsellor. In ADHC operated accommodation support services, formal debriefing or individual counselling is available for individuals and teams through the Employee Assistance Program on telephone 1300 687 327. This is a free service provided by registered psychologists.
8.4 Supporting other people with disability
Arrangements can be made, where required, for the bereaved person/s to receive support with communication and bereavement counselling. This may include making a referral to allied health specialists such as a psychologist for counselling. A speech pathologist can develop communication aids such as social stories to assist the bereaved person to understand and cope with the death of the person. There are resources available to support workers in considering how they can work best with others who are affected by a death. When assisting a person with disability to deal with grief and loss, support workers should consider the following points:
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• be honest, include and involve the person • listen, and be present for the bereaved person • actively seek out nonverbal rituals • respect photos and other mementos the bereaved person may have • minimise changes in routine, accommodation or caregivers • assist searching behaviour • support the observance of anniversaries • seek specialist help if behavioural changes persist. There are resources that support workers can use to support other people with disability to help them deal with the death of their friend (see Other resources).
9 Post death requirements
9.1 Cultural and linguistic diversity
Cultural sensitivity is important at this time. Around one in three NSW residents were born overseas, and one in five speaks a language other than English. Each person and family is unique. A culture and language assessment may be needed to establish the family’s requirements after death. If an interpreter is required, refer to the ADHC Language Service Guidelines (see Other resources). It is important to know if the deceased person and the family had developed an end of life care plan, before any arrangements are made. If end of life planning was done, confirm with the contact person that they want to implement the plan as it is, or make some changes. If end of life planning was not completed, even if the family is making its own funeral arrangements, it is important to establish if they have any rituals, ceremonies or taboos around the death of a person. The manager or a delegate can seek information from the family about the following: • the spiritual and religious beliefs, practices and taboos they wish to observe • how the person and the family communicate, such as the need for an interpreter, or the acceptability of certain words when discussing illness and dying • which member of the family or community is the contact person for problem solving and decision making, and the particular roles the family and community members have after the person dies.
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9.2 Aboriginal and Torres Strait Islander People
Aboriginal and Torres Strait Islander people have a number of customary practices at the time before death, when the person dies, and following death. Each family and community is unique, and this is dependent on his or her links and experiences. It cannot be assumed that all people follow the same practices. Significant impacts for Aboriginal and Torres Strait Islander people around death are included below however are not limited to the following.
9.2.1 Consent considerations and protocol Culturally appropriate consent Ask the person and their family member who in the family is the contact person to discuss issues around death and who provides consent. Record the name(s) and their roles and contact details on the person’s records. Issues of a sensitive nature and practices that are taboo Ask the person and their family member to explain what issues around death and dying are sensitive. Record this information on the person’s records.
9.2.2 Ceremonies and practices Ceremonies and practices around the death and dying Ask the family what and when they perform the ritual or practice. Record these ritual and/or practices in the person’s records so support workers are aware. Family and friend roles and responsibilities around death practices and ceremonies. Ask the person and/or their family who will be involved in the practice and/or ceremony. Record this information on the person’s records. The gathering of the family is part of the ceremony to help the spirit leave the person and move away. When the family gathers, the extended family gatherings may be large, and requires enough space and privacy and time for this to occur. Use of images and naming of the deceased Saying the person’s name or the putting up photos of the person is taboo as some Aboriginal and Torres Strait Islander people believe that it calls the spirit back.
9.2.3 Notifying the family of the death Cultural protocol for notifying the designated family member It may be inappropriate for a non-Aboriginal person known or unknown to the family to discuss any issues about the person and the death with the family member directly.
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The time of death is very significant for Aboriginal and Torres Strait Islander people. Cultural protocol is extremely important at this time. The designated family member must be contacted by the nominated service representative or an Aboriginal Liaison Officer. Coronial inquests may interfere with the practice of taking the deceased back to their land. Where possible, the family must be informed in advance that it is required by law everyone for receiving a disability service (even if they are absent at the time of death for example in a hospital or at the family home) to be the subject of a coronial enquiry. This will not stop the family’s rituals however it may delay some aspects. The way a person dies has different meanings for Aboriginal and Torres Strait Islander people. A sudden and unexpected death has a very different meaning to a slow and expected death.
9.2.4 Support When a person is accessing a service such as a hospital ask if they would like a referral to the Aboriginal Liaison Officer. If so, record this in the person’s records and support the person and their family member to access this service. Funding barriers may occur with the rituals the family wishes to practice, for example, gathering of the family, taking the body back to their land or the cost of the funeral. Discuss these issues with the designated family representative and refer the person, or support them to access Burial Assistance funding. For information and financial assistance regarding funeral services, the NSW Aboriginal Lands Council can also be contacted. Loss and grief support. If the family has access to an Aboriginal Liaison Officer they will ensure they are receiving support. (See Other resources for alternative support options). Where possible it is be best practice to contact Aboriginal Liaison Workers or Community Workers to assist with planning and preparation for the funeral and associated ceremonies.
10 Funeral arrangements
Families are generally responsible for arranging the funeral. If the person has a Lifestyle Plan or end of life care plan that outlines the person’s or the family’s funeral wishes, this should be followed. If the deceased does not have a family, guardian or advocate, support workers are responsible for arranging the funeral and advising friends, work associates, day placement, recreation services and service providers of the death of the person and the funeral arrangements. In cases where the family cannot afford the cost of the funeral, and the person’s estate cannot cover funeral costs, the manager can make a referral to the local Police and/or the NSW Aboriginal Lands Council for information and financial assistance.
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If the unit Manager contacts the NSW Aboriginal Lands Council, the Manager has responsibility to oversee the process. If the Manager makes a referral to the local police, the NSW Police are responsible for contacting the NSW Ministry of Health for financial assistance with burials and cremations for a person without means. The NSW Police advise the funeral director of the person’s death and that it is a destitute burial. The NSW Police complete the appropriate forms and forward them to the NSW Ministry of Health along with the funeral director’s invoice. The NSW Ministry of Health arranges payment to the funeral director. The line manager supports the person’s peers and other support workers to attend the funeral and may: • liaise with families about funeral arrangements • transport other people with disability to and from the funeral and post- funeral gathering • consider the option of other people with disability and support workers to view the deceased person if this is available and applicable • provide, and organise for communication tools and strategies to be developed to assist other people with disability to understand what to expect at the funeral.
11 Estate management
In cases where the person does not have a will, the manager will seek direction from the NSW Trustee and Guardian. If the person made a will, the person’s solicitor and Executor manage the closure of any financial business on behalf of the person. For ADHC operated accommodation support services and other services refer to the Personal Finance Procedures - estate management for further information. ADHC staff can seek further advice from FACS Legal if they are unsure about estate management for a person who was receiving ADHC services.
12 The person’s bedroom and assets
The deceased person’s belongings are to be secured by closing or, if possible, locking the person’s door. If any of the deceased person’s possessions are elsewhere in the house they are returned to the person’s room. Nothing is to be removed from the person’s bedroom until after the NSW Trustee and Guardian or Executor has given instructions. Support workers are not to clean the bedroom or change it in anyway. After the death, the parents and family may wish to spend time in the person’s room as part of their grieving.
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After the funeral the manager will be required to complete an asset stock take against the existing asset register. When the stock take has been completed the person’s assets are placed in a secure storage facility until instructions are given by the NSW Trustee and Guardian or the Executor of the will. A copy of the asset register is placed in storage with the deceased person’s possessions. If the person has a will, the original copy is placed on the person’s file and a copy is provided to the solicitor.
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13 Explanation of terms
Term Explanation Accommodation This term refers to Large Residences, Specialist Supported support Living centres, Assisted Boarding Houses, group homes, services centre-based respite and in-home support for ADHC operated and funded non-government accommodation support services. Advance Care An ACD records the person’s preference for future care and Directive (ACD) appoints a substitute decision-maker to make decisions about health care, and personal life issues management. ACDs have legal status and are recognised under the law. The ACD comes into effect when the person loses the capacity to make decisions e.g. the person is in a coma. In NSW an ACD usually contains details of a person’s health management preferences: • any values and beliefs that may guide future treatment instructions regarding the future use or restriction of particular medical treatments • details of who the person wants to make decisions for them when they are no longer able. Advance Care An advance care planning discussion will often result in an Plan (ACP) ACP. The ACP records the person’s preferences about health and preferred outcomes. It may be developed on the person’s behalf, and is prepared from the person’s perspective to guide decisions about treatment and care. It may be verbal or written. It should inform a Resuscitation Plan or Palliative Care Plan. Assisted Under Section 37 of the Boarding Houses Act 2012, an Boarding House assisted boarding house is: • a boarding house premises that provide beds, for a fee or reward, for use by 2 or more residents who are persons with additional needs • a boarding premises that are declared to be an Assisted Boarding House by a notice in force under section 39 of the Act.
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Term Explanation Bereavement, The support provided to people who are experiencing bereavement bereavement or grief following the death of a significant support and person. counselling Bereavement is the response to a loss and includes the process of ‘recovery’ or healing from loss. Each person will grieve and recover in his or her own way. Bereavement counselling is provided to people who have experienced the death of someone close to them. Client Death The CDN form is to be completed as a mandatory Notification requirement of ADHC funded and operated accommodation (CDN) form support services, and Assisted Boarding House, to notify the Ombudsman of the death of a person. Child A person under the age of 18 years (as per Section 24(3) of the Coroners Act 2009). Conditions of The set conditions or requirements prescribed to an assisted License boarding house with which they are legally required to comply. Each Assisted Boarding House has a set of conditions that are issued in accordance with the Boarding Houses Act 2012 and the Boarding Houses Regulation 2013. CS CRAMA Community Services (Complaints, Reviews and Monitoring) 1993 Act 1993 Performance When an unexpected death occurs, PI oversees the internal Improvement review process and provides advice as required. PI is (PI) Unit responsible for liaising with the NSW Ombudsman on the death of a person including providing their office with copies of the relevant reports. PI also has a lead role in responding to systemic recommendations through remedial actions and identifying opportunities to prevent and respond to deaths of people with disability in ADHC operated accommodation and centre-based services. End of life care End of life care planning is a process of planning for future planning care whereby the person’s values, beliefs and preferences are made known, so they can guide decision-making at a future time when the person is unable to make or communicate decisions. This allows the person to choose the type of care and support to live and die well in their preferred place. The planning process allows the person with disability to understand dying and death, as part of a natural cycle of life and to develop self determined wishes. Where a person has limited capacity to make decisions, families can assist the person to make plans through supported shared planning.
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Term Explanation Expected death An expected death is when a person has a progressive, advanced disease or terminal illness, or the person chooses not to pursue curative treatment. Health Care A plan prescribed by a health professional such as the Plan person’s usual general practitioner which outlines advice, recommendations and timeframes for the completion of health actions for the person. In ADHC operated accommodation support services, the health care plan is known as the My Health and Wellbeing Plan. Lifestyle Plan A ‘living’ plan that belongs to the person and which represents the person’s wishes and lifestyle choices. The Lifestyle Plan includes an Action Plan which describes all the actions that are needed to help the person achieve their goals and dreams. Mandatory The CS CRAMA requires reviewable deaths to be reported to reporting the NSW Ombudsman. The Coroners Act 2009 requires certain deaths or suspected deaths to be reported to the NSW Police and State Coroner. Manager In ADHC operated disability services this term refers to Team Leaders, Coordinators Accommodation and Respite, Registered Nurse Unit Managers, Nurse Manager Accommodation and Nursing Services, and any manager in the reporting line. Ombudsman The NSW Ombudsman is an impartial watchdog who is independent of the government of the day and accountable to the public through the NSW Parliament. The Ombudsman carries out his role under the Community Services (Complaints, Reviews and Monitoring) Act 1993, Ombudsman’s Act 1974 and the Commission for Children and Young People Act 1998. The Ombudsman’s role includes reviewing the deaths of certain children, young people and people with disabilities in care (called ‘reviewable deaths’). End of Life Care A written plan developed with the person, the family or Plan guardian, the person responsible and the services involved in providing care to the person. The End of Life Care Plan is a person centred approach to planning the person’s care. It aims to support the person, their person responsible and family or guardian, to direct and influence the person’s treatment and quality of life.
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Term Explanation Person A person responsible is someone who has the authority to responsible consent to medical or dental treatment for an adult who is unable to give or refuse consent for their own treatment. As stated in the Guardianship Act 1987, a ‘person responsible’ only exists where the person is unable to give informed consent. The person responsible is not necessarily the person’s next of kin. There is a hierarchy of people who can be the person responsible. Refer to the Decision Making and Consent Policy (in the ADHC Lifestyle Policy and Practice Manual) for information on the person responsible. Police The NSW Police attend the death of a person under the care of an accommodation support service even if at the time of the death the person was temporarily absent from their usual residence, such as, in hospital. The NSW Police are required to place an identification tag on the body and report the death of a person with disability to the State Coroner. The NSW Police are also required to arrange transport of the deceased to the State Coroner. Resuscitation A Resuscitation Plan is a medically and legally enforceable, Plan (previously authorised order to use or withhold resuscitation measures, known as No and documents any other time critical clinical decisions CPR Orders) related to end of life. For more information and template see Other resources – Resuscitation Plans in End of Life Decisions – NSW Health. Reviewable The Reviewable Disability Death Team within the Community Disability Death Services Division of the NSW Ombudsman. Team State Coroner The State Coroner considers each death to determine the manner and cause of death and to decide whether an inquest is necessary. Section 36 of the Coroners Act 2009 requires the State Coroner to inform the NSW Ombudsman about certain child or disability deaths. These requirements are in addition to the requirements of Part 6 (‘reviewable deaths’) of the CS CRAMA. Senior Manager In ADHC this refers to the manager who has the authority to act in a given situation. TRIM FACS’ current document tracking system. Unexpected An unexpected death is when a person dies suddenly and death unpredictably.
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14 Policy and Practice Unit contact details
You can get advice and support about this Policy from the Policy and Practice Unit, Contemporary Residential Options Directorate.
Policy and Practice Unit Contemporary Residential Options Directorate ADHC [email protected]
If you are reviewing a printed version of this document, please refer to the Intranet to confirm that you are reviewing the most recent version of the Policy. Following any subsequent reviews and approval this policy will be uploaded to the internet/and/or intranet and all previous versions removed.
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15 Index of flowcharts
Flow chart 1: Immediate action and response required within 1 to 2 hours of a person’s death
IMMEDIATE ACTION if person is found unresponsive
All services: ADHC operated and funded accommodation support services; Assisted Boarding Houses
Apply first aid and call 000 for an Ambulance. Refer to the person’s Advance Care Directive / Acute Resuscitation Plan (if applicable) If the person is resuscitated refer Notify your line manager to advice of: (or on call manager) - Ambulance officer - Medical practitioner Continue first aid until Ambulance arrives. Hand over to Ambulance Officers Refer to information outlined in the person’s - Health care plan DEATH IS DECLARED by Ambulance -End of life, Palliative Care, Officer or Medical Practitioner if present Advance Care or Treatment Plans - Hospital Plan
RESPONSE WITHIN 1 - 2 HOURS
Manager of all services notifies next of kin Manager of an Assisted Boarding or guardian Houses reports the matter to the Police and FACS as soon as reasonably possible (i.e. within 24 Manager of ADHC operated and funded hours). services calls local Police to attend to the Manager to report to FACS the death in all circumstances attendance of any police officer at the boarding house to investigate Manager of all services notifies the death as soon as reasonably WorkCover on 13 10 50 possible (i.e. within 24 hours).
ADHC operated disability services
Local Police make arrangements Manager completes letters for Police and to transport the deceased to the State Coroner State Coroner
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Flow chart 2: Action required when the NSW Ombudsman submits a complaint or requests further information
NSW Ombudsman Submits complaint and / or request for further information
Deputy Secretary Disability Operations Corresponds directly with the NSW Ombudsman
Deputy Secretary Disability Operations Corresponds with the District Director or equivalent position
District Director Forwards and receives correspondence with the relevant service
ADHC funded support ADHC operated support services Assisted Boarding Houses services ▪ Assesses allegations or ▪ Assesses allegations or ▪ Investigates allegations or concerns raised concerns raised concerns ▪ Provides a proposed ▪ Provides a proposed ▪ Provides a proposed response to the District response to District Director response to the District Director by the due date by the due date provided Director provided ▪ Retain copies of original ▪ Retain copies of original ▪ Retain copies of original files at the services at the files at the service at which files at the services at the which the deceased person the deceased person resided which the deceased person resided resided
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Flow chart 3: Action required within 48 hours of a person’s death
ACTION WITHIN 48 HOURS OF A PERSON’S DEATH
Children, young people and adults Assisted Boarding Houses receiving ADHC operated support Children, young people services and adults receiving ADHC funded support Refer to the Assisted services including Boarding Houses accommodation support, Authorisation and respite, community Monitoring Manual access programs
Accommodation Other disability support and respite services e.g. e.g. group homes; Large Community Support Residential Centres; The Manager informs Teams; community Specialist Supported the District Directoror access programs Living; centre-based equivalent of the death respite of the person.
Unexpected Expected Procedures may be death death adapted or adopted according to organisational and operational structure.
The District Director endorses the Briefing Note and Incident Report, CDN form and all relevant attachments and faxes to FACS Performance Improvement Refer to funded organisational procedures for additional information
If death is unexpected and / or unexplained FACS Performance Improvement forwards Briefing Note and Incident Report to the Deputy Secretary Disability Operations for review and endorsement
FACS Performance Improvement forwards Briefing Note, Incident Report CDN form and all relevant attachments to the NSW Ombudsman and Law & Justice not later than 30 days after receipt of advice
The NSW Ombudsman responds to the death of the person to FACS Performance Improvement and requests further information to be provided
Death Procedures, V1.1, November 2016 39 Category 1 Incident – Executive Briefing (Revised October 2016)
FACS Incident Reporting and Management Guidelines – Appendix C
Section A: Incident key details for incident involving a client (Attach a separate sheet for incidents involving multiple clients)
Client name: Click here to enter text. Date of Birth: Click here to enter text.
Address: Click here to enter text.
District/Directorate: Click here to enter text. CIS ID: Click here to enter text.
TRIM Ref №: Click here to enter text. Date of Incident: Click here to enter text.
Is an Incident Report Form (Appendix B) attached? ☐ Yes ☐ No
Is this a Part 3C reportable incident? ☐ Yes ☐ No
Does this incident involve a child or young person? ☐ Yes ☐ No
Have you made a Community Services report? ☐ Yes ☐ No
Has a Police report been made? ☐ Yes ☐ No Event Number: Click here to enter text. Has counselling been offered? If yes, to who? ☐ Yes ☐ No Click here to enter text.
Details about staff reporting this incident
Name: Click here to enter text. Worksite name: Click here to enter text.
Phone №: Click here to enter text. Email: Click here to enter text.
Section B: Provide a brief description of the incident (Attach a separate sheet if required)
Is a complaint likely to be lodged? ☐ Yes ☐ No
Is this incident likely to draw attention from the media? ☐ Yes ☐ No
FACS Incident Reporting and Management Guidelines for People Accessing Ageing and Disability Direct Services – Appendix C Page 1 of 4
Category 1 Incident – Executive Briefing (Revised October 2016)
FACS Incident Reporting and Management Guidelines – Appendix C
Section C: Endorsement Role Name Signature Date Click here to Manager Click here to enter text. Click here to enter text. enter text. Click here to Director Click here to enter text. Click here to enter text. enter text. Click here to Executive Director Click here to enter text. Click here to enter text. enter text. Deputy Secretary Click here to ADHC Click here to enter text. Click here to enter text. enter text. (ISP and CJP only) Deputy Secretary Click here to Disability Click here to enter text. Click here to enter text. enter text. Operations
This completed form must be submitted within 24 hours of the Category 1 Incident occurring via email to:
• Deputy Secretary Disability Operations at ADHC Reportable Incidents Team [email protected] and [email protected]
Seek advice from the Reportable Incidents Team if you need assistance with completing this form.
FACS Incident Reporting and Management Guidelines for People Accessing Ageing and Disability Direct Services – Appendix C Page 2 of 4
Category 1 Incident – Executive Briefing (Revised October 2016)
FACS Incident Reporting and Management Guidelines – Appendix C
Section D: Information on Category 1 Incidents
Category 1 Incidents are considered critical and require reporting to the Report to ADHC Executive (see Appendix D) and may also require reporting to the ADHC NSW NSW Ombudsman (NSW Ombo). Exec Ombo An incident involving any of the following in connection with an employee (including agency staff, volunteers and contractors) of FACS and a person with disability living in supported group accommodation: • any sexual offence committed against, with or in the presence of the person with disability • sexual misconduct committed against, with or in the presence of the person with disability, including grooming the person for sexual activity • an assault of the person with disability (not including the use of physical force that, in all the circumstances, is trivial or negligible, but only if the matter is to be investigated under workplace employment procedures) • an offence under Part 4AA of the Crimes Act 1900 (fraud and similar offences) committed against the person with disability or • ill-treatment or neglect of a person with disability. An incident involving an assault of a person with disability living in supported group accommodation by another person with disability living in the same supported group accommodation that: • is a sexual offence • causes serious injury, including for example, a fracture, burns, deep
cuts, extensive bruising or concussion • involves the use of a weapon • is part of a pattern of abuse of the person with disability by the other person. An incident occurring in supported group accommodation and involving a contravention of an apprehended violence order made for the protection of a person with disability, regardless of whether the order is contravened by an employee of FACS or a funded provider, a person with disability living in the supported group accommodations or another person. An incident involving an unexplained serious injury to a person with disability living in supported group accommodation. A FACS employee has engaged in an incident giving rise or harm to a child or young person for which a report is made to Community Services A member of the public (not a FACS employee) has engaged in an incident giving rise of harm to a child or young person for which a report is made to
Community Services.
FACS Incident Reporting and Management Guidelines for People Accessing Ageing and Disability Direct Services – Appendix C Page 3 of 4
Category 1 Incident – Executive Briefing (Revised October 2016)
FACS Incident Reporting and Management Guidelines – Appendix C
Section D: Information on Category 1 Incidents
Category 1 Incidents are considered critical and require reporting to the Report to ADHC Executive (see Appendix D) and may also require reporting to the ADHC NSW NSW Ombudsman (NSW Ombo). Exec Ombo A member of the public (not a FACS employee) has engaged in suspected mistreatment or neglect of a person with disability who is in receipt of FACS services.
Threat to the safety or wellbeing of people accessing Direct Ageing and Disability Services (e.g. bomb, threat to harm with a weapon, threat to sabotage). An incident that almost certainly will result in an adverse impact including negative media attention for FACS, the Deputy Secretary, Secretary and/or
Minister (e.g. industrial action, loss of provision of critical services for an extended period, significant financial loss or misappropriation). Death, which was unexpected, of a person while living in a FACS Ageing or Disability Direct Service.
FACS Incident Reporting and Management Guidelines for People Accessing Ageing and Disability Direct Services – Appendix C Page 4 of 4
Electronic Version Client Death Notification Form (CDN) Office use only Text references e.g.1 refer to notes in Guidelines for Completion (p 5-6) ADHC TRIM NO:
Person's details Family name: Given name(s): Date of birth: Gender: Male Female Transgender Aboriginal or Torres Strait Islander1: Yes No Don't know Country of birth: First language2: English Other (specify): How did the person communicate?3 Verbal language Adjusted verbal language Sign language Other signing/gestures Pictures Electronic Other (specify):
Details of death Please provide copies of relevant Critical Incident Reports and/or Incident Briefing Notes
Date and time Place of death Date of death: At the residence At hospital (specify) Time of death: Other (specify) Unexpected death Expected death (attach end-of-life, palliative care or treatment plan) Provide details of the person’s terminal illness/ reason why death was expected:
Brief description of the key events leading up to the person’s death4
Accommodation Name of service provider5 Postal address: Postcode: Contact person: Title: Telephone: Place of residence6 : District (ADHC) operated service Funded7 service Assisted boarding house Group home (< 7 people) Group home (< 7 people) Small residential (7-20 people) Small residential (7-20 people) Large residential (>20 people) Large residential (>20 people) Respite - group home Respite - group home Respite - large residential Respite - large residential
Other (specify):
Person’s length of time at this residence: Length of time in accommodation services during lifetime:
Number of residents living at this address: Names of other residents who died at service outlet8 in last 12 months
Respite stays Overnight respite stays in previous 12 months: No Yes
Client Death Notification Form (CDN) Electronic Version Last updated October 2016 PRIVATE AND CONFIDENTIAL 1 of 7 Electronic Version
Client Death Notification Form (CDN) Electronic Version Last updated October 2016 PRIVATE AND CONFIDENTIAL 2 of 7 Electronic Version Disability Intellectual Borderline Mild Moderate Severe Profound Unknown level Syndrome Down syndrome Fragile X Rett syndrome Other (specify):
Neurological Dementia Multiple sclerosis Muscular dystrophy Other (specify):
Mental illness Schizophrenia Depression Bipolar disorder Anxiety Other (specify):
Sensory impairment Vision (specify): Hearing (specify):
Physical Cerebral Palsy (including spastic quadriplegia) Spinal cord injury Other (specify):
Other disability Autism spectrum disorder Acquired brain injury Other (specify):
Swallowing, breathing and choking risks Asthma Recurrent respiratory infections Chronic obstructive pulmonary disease (COPD)/ emphysema Gastroesophageal reflux (&/or oesophagitis) Swallowing difficulties8 Help with meals10 Tube feeding11 (specify): Was the person nil by mouth? 12 Yes No
Previous choking incidents (specify date/s): Did the person have: All their teeth Some teeth No teeth Dental aid13 Smoking, obesity and other lifestyle risks Diabetes High blood pressure Last recorded weight before death: (kg) Date: Weight 3 months before that: Last recorded height before death: (cm) Date: (kg) Date: Smoking Occasional Up to 10/day 11-20/day >20/day No Ex smoker Mobility Limited mobility14 No Wheelchair Walking frame Walking stick Other (specify): Other health issues Cancer Epilepsy Osteoporosis Constipation Urinary incontinence15 Faecal incontinence16 Other (specify):
Immunisation Yes No Date Don't Immunisation Yes No Date Don't immunised know immunised know Influenza Pneumococcal Other (specify)
Medication and consent List all medications the person was prescribed at the time of death. Indicate dosage, and regular17 or PRN18: Item Dosage Regular PRN Item Dosage Regular PRN
Any other medications prescribed for the person in the last 12 months19 Client Death Notification Form (CDN) Electronic Version Last updated October 2016 PRIVATE AND CONFIDENTIAL 3 of 7 Electronic Version
Were there any medication incidents20 in the last 12 months? No Yes (specify): Responsible for consent21 Person themselves Family member Friend Public Guardian Private Guardian Other (specify): Health providers General Practitioners Date of last Date last comprehensive annual review visit
Practitioner/profession Date last visit Provider’s name Hearing Vision Allied health Speech pathologist Dietician Occupational therapist Physiotherapist Dentist Psychologist Other (specify) Medical specialist Neurologist Cardiologist Psychiatrist Gastroenterologist Other (specify) Multidisciplinary Palliative care teams Dysphagia clinic Other (specify) In the 12 months before the person’s death Behaviour Did the person display behaviours of concern:22 No Self injury23 Absconding24 Eating non-food items (Pica) Assault of other clients Assault of others Other behaviours of concern (specify): Were restrictive practices25 used: No Yes (specify): Illnesses Did the person have any illness that required treatment by a doctor? (e.g. chest infection) No Yes (specify below) Date Brief details
Hospital admissions Was the person admitted to hospital?26 No Yes (specify below) Date Hospital Reason/s for admission
Client Death Notification Form (CDN) Electronic Version Last updated October 2016 PRIVATE AND CONFIDENTIAL 4 of 7 Electronic Version Injuries Did the person have any serious injuries? No Fracture Deep cuts Extensive bruising Concussion Burns Other Date Brief details (please provide any incident reports)
Falls Did the person experience any falls? No Yes (specify below)27 Date Brief details
Please provide any other relevant information about the person not provided above
Documents required with the Client Death Notification form With this form, please provide any current risk assessments and relevant support plans, 28 including: health care plan29 client risk plan assessment/s of nutrition, swallowing and/or choking risks specific health support plans, including any relating to eating and drinking; epilepsy management; asthma/ respiratory illness; diabetes management; bowel care; palliative care, etc behaviour support plan and/or incident prevention and response plan Notification to Police30 Date: Notifying person: Police Station: Name and rank of police officer: COPS Event No (if known): Checklist for Completion (see Guidelines) I have completed the following (please tick): Signed and dated CDN Emailed CDN to: [email protected], Performance Improvement, FACS within 48 hours of person’s death Posted the following documents to Performance Improvement, FACS, Locked Bag 10, Strawberry Hills NSW 2012: CDN form copies of Critical Incident Reports31 / Incident Briefing Notes32 about the death copies of relevant risk assessments and support plans (see previous section)
Form completed by (please print name): Date:
Signature …………………………… Position title: Telephone:
ADHC Senior Manager: Line Manager: Operations Executive Director, Disability Operations:
Client Death Notification Form (CDN) Electronic Version Last updated October 2016 PRIVATE AND CONFIDENTIAL 5 of 7 Electronic Version Guidelines for Completion of Client Death Notification Form The service provider fills out the Client Death Notification (CDN) form and submits it to Performance Improvement, Department of Family and Community Services NSW, no later than 48 hours after the person’s death. At this time, or as soon as possible, the service provider also sends the associated documents (health care plans, briefing notes etc) to Performance Improvement, who will send all these documents to the NSW Ombudsman’s Office.
Ref CDN question Guidelines for completion Person's Details 1. Aboriginal or Torres Strait Islander Tick ‘Yes’ if this is recorded on the person’s file. 2. First language Indicate which language the person preferred. If the person was largely non-verbal, indicate which language their family used to communicate with them. 3. Support for communication This may have been necessary if the person had limited expressive and/or receptive communication skills. Support examples include use of gestures, adjusted verbal language, signing, pictures and electronic devices, hearing aid. Details of Death 4. Brief description of key events Provide a brief summary of what happened in the lead-up to the person’s death (particularly the last 24 hours). Accommodation 5. Name of service provider Write full details of the service provider’s head office, if applicable. 6. Person’s place of residence Write full details of the specific service outlet including the Unit name/number at which the person resided. 7. Funded service Includes services funded by FACS and those funded under the National Disability Insurance Scheme (NDIS) – including services that are solely funded under the NDIS. 8. Service outlet The service outlet refers to the group home or other disability accommodation the person resided in. In the case of a residential centre, the service outlet is the unit they lived in. Swallowing, breathing and choking risks 9. Swallowing difficulties Tick if person had been identified as having dysphagia (swallowing problems), or if the person required foods and fluids of different texture e.g. minced/ pureed food, or thickened fluids. Do not tick if this only occurred during a final hospital admission before death. 10. Help with meals Tick if the person needed help to chop food up (or mince or blend) and/or help to use utensils to eat. Do not tick if the person needed help with cooking. 11. Tube feeding Tick if the person received food/ fluid via a tube. Specify which type, eg: nasogastric, PEG (percutaneous endoscopic gastrostomy), or jejunostomy. 12. Nil by mouth Tick if the person did not take any food and/ or fluid via their mouth, and they received all food and fluid via a tube. Do not tick if this only occurred during a final hospital admission before death. 13. Dental aid A dental aid refers to items such as dentures. Some people may have some of their own teeth and a partial denture. Smoking, obesity and other lifestyle risks 14. Limited mobility This refers to decreased ability to move freely without assistance or without risk of falling. Other aids may include a hoist or assistance from a carer. Other health issues 15. Urinary incontinence Tick if the person had decreased ability to control their passing of urine.
Client Death Notification Form (CDN) Electronic Version Last updated October 2016 PRIVATE AND CONFIDENTIAL 6 of 7 Electronic Version 16. Faecal incontinence Tick if the person had decreased ability to control the emptying of their bowel. Medication and consent 17. Regular medication Medication taken on a regular basis. 18. PRN medication Medication taken as needed. 19. Other medications in last 12 months List any medications prescribed for the person in the last 12 months that were ceased before their death. 20. Medication incidents Any incident where medication was not given as required. For example, the wrong medications were given, medications were missed or were given at the wrong time, or the wrong dose was given. 21. Responsible for consent Indicate who was responsible for providing consent to medical and dental treatment on the person’s behalf. In the 12 months before the person ’s death 22. Behaviours of concern Behaviour that is of such intensity, frequency or duration that the quality of life and/or physical safety of the person or others is put at risk. 23. Self injury Examples are self-hitting, banging head, biting, cutting, scratching or picking skin, burning and eye-poking. 24. Absconding The person left a place without the agreement of those responsible for their care. 25. Restrictive practices Restrictive practices refer to methods that involve some intrusion on the person’s freedom in order to curtail a particular behaviour. May include physical or chemical restraint and seclusion or containment. 26. Hospital admissions This refers to a full admission to hospital or a short-term presentation to an Accident and Emergency department. 27. Falls Include any falls experienced by the person in the last 12 months, regardless of their cause. Documents required with the Client Death Notification form 28. Current risk assessments and relevant Please provide any assessments and/or support plans that relate to the support plans health issues, risks and support needs for the person you have identified in the CDN. 29. Health care plan Any document that provides a comprehensive overview of the person’s health needs and outlines the actions required to meet those needs. Notification to Police 30. Notification to Police Under the Coroners Act 2009, service providers are required to report the person’s death to a police officer, coroner, or assistant coroner as soon as possible after the death. Checklist for Completion 31. Critical incident reports A staff member’s report of a significant incident or event that represented potential danger to the person or other people. 32. Briefing notes A short, written outline provided to management about the death.
Client Death Notification Form (CDN) Electronic Version Last updated October 2016 PRIVATE AND CONFIDENTIAL 7 of 7
Death Procedures
Document name Death Procedures
Policy Health and Wellbeing Policy
Version number 1.1
Approval date January 2016
Policy manual Health and Wellbeing Policy and Practice Manual, Volume 2
Approved by Deputy Secretary, ADHC
Summary The Death Procedures provide instructions for support workers and managers to follow when a person dies.
Replaces document Client Death Policy and Procedures 2012
Authoring unit Contemporary Residential Options Directorate
Applies to People receiving support in ADHC operated and funded non-government accommodation support services, centre-based respite, drop-in support and assisted boarding houses.
Review date 2017
Version control The first and final version of a document is version 1.0. The subsequent final version of the first revision of a document becomes version 1.1. Each subsequent revision of the final document increases by 0.1, for example version 1.2, version 1.3 etc.
Revision history
Version Amendment date Amendment notes
V1.0 January 2016 Replaces the Client Death Policy and Procedures 2012
V1.1 November 2016 Amended to update reporting of Category 1 incidents to Performance Improvement
Death Procedures, V1.1, November 2016 2
Table of contents 1 Death of a person ...... 5 1.1 Legal and Legislative Framework ...... 5 1.2 Application of Procedures: Table A ...... 10 2 Unresponsive person ...... 13 2.1 Apply First Aid and call an Ambulance ...... 13 2.2 Notify the next Line Manager ...... 13 2.3 Attendance of Ambulance ...... 13 2.4 Admission to Hospital ...... 14 3 Deceased person ...... 14 4 Response within 1 to 2 hours of death ...... 14 4.1 Notify management ...... 14 4.2 Notify next of kin or guardian ...... 15 4.3 Report the person’s death to NSW Police ...... 16 4.4 Letters for NSW Police and State Coroner ...... 16 4.5 Report the death to WorkCover ...... 17 4.6 Transportation of the deceased ...... 18 5 Response within 24 to 48 hours of death ...... 18 5.1 ADHC operated accommodation support services ...... 18 5.2 Other ADHC operated services ...... 19 5.3 ADHC funded non-government disability support services ...... 19 5.4 Briefing Note ...... 19 5.5 Attachments to the Briefing Note ...... 20 6 Response 48 hours after death ...... 21 6.1 ADHC operated accommodation support services ...... 21 6.2 Reporting to the NSW Ombudsman ...... 21 6.3 Notifying internal FACS Services...... 22 6.4 Notifying external services ...... 22 6.5 Internal review of the death ...... 22 7 Responding to the NSW Ombudsman ...... 23 7.1 ADHC operated accommodation support services ...... 23 7.2 ADHC funded non-government disability support services and Assisted Boarding Houses ...... 24 7.3 FACS Performance Improvement Unit ...... 25 8 Bereavement support ...... 25
Death Procedures, V1.1, November 2016 3
8.1 Informing other people ...... 25 8.2 Supporting the family ...... 25 8.3 Supporting support workers ...... 26 8.4 Supporting other people with disability ...... 26 9 Post death requirements ...... 27 9.1 Cultural and linguistic diversity ...... 27 9.2 Aboriginal and Torres Strait Islander People ...... 28 10 Funeral arrangements ...... 29 11 Estate management ...... 30 12 The person’s bedroom and assets ...... 30 13 Explanation of terms ...... 32 14 Policy and Practice Unit contact details ...... 36 15 Index of flowcharts ...... 37
Death Procedures, V1.1, November 2016 4
1 Death of a person
The ADHC Death Procedures (the Procedures) embody the principles of legal and human rights found in the New South Wales Disability Service Standards (the Standards), the commitment to deliver culturally responsive services to Aboriginal and Torres Strait Islander people under the Aboriginal Policy Statement and the person centred guiding principles of the ADHC Health and Wellbeing Policy. The following section provides direction to support workers in the event of a person becoming unresponsive, or if an unresponsive or deceased person is found. The Procedures are mandatory for ADHC operated accommodation support services, centre-based respite, drop-in support, Large Residential Centres and Specialist Supported Living, and must be followed in sequence. Flowcharts are provided at the end of these Procedures to assist support workers and managers, and reflect the contents of the following sections. Some of the response and reporting requirements are binding under the law and apply to ADHC funded non-government accommodation and other support services, including assisted boarding house1 (Section 1.1). ADHC funded non- government service providers should familiarise themselves with the sections that apply to them. Assisted Boarding Houses are required to follow these Procedures as specified in the Assisted Boarding House Authorisation and Monitoring Manual2.
1.1 Legal and Legislative Framework
The key relevant laws in relation to these procedures are set out below. Table A summarises the responsibilities of service providers under the legislation. Mandatory reporting requirements, of the death or suspected death of a person with disability, to the NSW Police and State Coroner are covered under the following sections of the Coroners Act 2009. They apply to both ADHC operated and ADHC funded non-government disability support services and Assisted Boarding Houses. The legislative requirements are detailed in the following tables.
1 Under the Boarding Houses Act 2012, all boarding houses that have two or more ‘persons with additional needs’ must be authorised and licensed by FACS, and are known as assisted boarding houses.
2 http://www.adhc.nsw.gov.au/publications/policies/policies_a-z/?result_237652_result_page=A
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Coroners Act 2009 Section 24 Jurisdiction concerning deaths of children and disabled persons Section 24(1) gives jurisdiction for a senior coroner to hold an inquest into the death or suspected death of any person with disability who at the time of their death were receiving support from an accommodation support service that is funded non-government or operated by ADHC under the Disability Inclusion Act 2014 or an assisted boarding house under Part 4 of the Boarding Houses Act 2012. This includes a person who, at the time of death, was temporarily absent from an ADHC operated or funded non-government accommodation support service, centre-based respite or an assisted boarding house, for example, in hospital. Section 35 Obligation to report death or suspected death Requires that a death or suspected death of a person under Section 24(1) must be reported to a police officer, a coroner or an assistant coroner as soon a possible after becoming aware of the death. Section 36 State Coroner to inform the NSW Ombudsman about certain child or disability deaths Requires the State Coroner to provide to the NSW Ombudsman all relevant material regarding the death or suspected death of any person under Section 24(1). Section 38 Medical practitioner must not certify cause of death if death is reportable An attending medical practitioner is not permitted to issue death certificates for people who are under the care of an accommodation support service as per Section 24(1), or who are temporarily absent from an accommodation support service at their time of death, such as a person who dies in hospital.
Mandatory reporting requirements of a death or suspected death of a person with disability to the NSW Ombudsman are covered under the following sections of the Community Services (Complaints, Reviews and Monitoring) Act 1993 and apply to both ADHC operated and ADHC funded non-government support services as well as assisted boarding houses.
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Community Services (Complaints, Reviews and Monitoring) Act 1993 Section 35 Application of Part 1) This Part applies in respect of the deaths of the following persons (in this part referred to as “reviewable deaths”): a. a child in care b. & c. repealed d. a child whose death is or may be due to abuse or neglect or that occurs in suspicious circumstances, e. a child who, at the time of the child’s death, was an inmate of a children’s detention centre, a correctional centre or a lock- up (or was temporarily absent from such a place), f. a person (whether or not a child) who, at the time of the person’s death was living in, or temporarily absent from, residential care provided by a service provider or an assisted boarding house (in this Part referred to as a “person in residential care”), g. a person (other than a child in care) who is in a target group within the meaning of the Disability Inclusion Act 2014 who receives from a service provider assistance (of a kind prescribed by the regulations) to enable the person to live independently in the community. 2) In this Part “Assisted boarding house” includes premises that were a residential centre for handicapped persons (within the meaning of this Act before it was amended by the Boarding House Act 2012) at the time of the death concerned. "Child" means a person under the age of 18 years. Section 6 Service provider means: a. the Department of Family and Community Services (FACS) b. an implementation company under the National Disability Insurance Scheme (NSW Enabling Act 2013) while the company is a public sector agency of the State under that Act or c. a person or organisation funded by the Minister for Family and Community Services, the Minister for Ageing or the Minister for Disability Services to provide a service, or d. a person or organisation authorised or licensed by the Minister for Family and Community Services, the Minister for Ageing or the Minister for Disability Services to provide a service, or e. the Home Care Service of NSW or a person or organisation funded by the Home Care service to provide a service or f. a person or organisation that is covered by an arrangement
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Community Services (Complaints, Reviews and Monitoring) Act 1993 made after 7 April 1994 (the date of commencement of this section) between a Minister of the State of New South Wales and a State or Commonwealth Minister, under which arrangement that State or Commonwealth Minister agrees to the person or organisation being a service provider for the purposes of this Act3, or g. an authorised carer or designated agency within the meaning of the Children and Young Persons (Care and Protection) Act 1998, or h. the proprietor or occupier of premises that consist of an assisted boarding house. Section 37 The Deputy Secretary of ADHC must provide the Ombudsman with (2) & (4) copies of any notification received by the Deputy Secretary relating to a reviewable death not later than 30 days after receiving the notification. The Deputy Secretary of ADHC means the person employed by FACS as the Deputy Secretary of ADHC, or if there is no such person, the Secretary of the Department.
All staff have a legal duty to provide assistance to an unresponsive person under Section 44 of the Crimes Act 1900.
Crimes Act 1900 Section 44 Failure of persons to provide necessities of life 1) A person a. Who is under a legal duty to provide another person with the necessities of life, and b. Who, without reasonable excuse, intentionally or recklessly fails to provide that person with the necessities of life, is guilty of an offence if the failure causes a danger of death or causes serious injury, or the likelihood of serious injury to that person. Necessities of life refer to those things necessary to preserve life, such as food, shelter, medical attention and protection from harm.
Mandatory reporting requirements of a death or suspected death of a person with disability to the Deputy Secretary (formerly the Director General) are covered under the following sections of the Boarding House Act 2012.
3 Note: There is a Ministerial arrangement made under paragraph (f) which means that service providers includes those who provide services to recipients in the NDIS trial site).
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Boarding House Act 2012 Section 83 Notification of deaths, sexual assaults and other incidents involving residents of authorised boarding houses 1) The manager of an authorised boarding house must, as soon as is reasonably possible after becoming aware of any of the following incidents, report the incident to the Deputy Secretary: a. the death of a resident of the assisted boarding house, b. (not relevant to these Procedures) c. (not relevant to these Procedures) d. (not relevant to these Procedures) 2) The manager must also report the death (or the sexual assault or the making of an allegation of sexual assault) of a resident of the authorised boarding house to a police officer as soon as is reasonably practicable after becoming aware of the incident concerned. 3) A manager of an assisted boarding house who contravenes this section is guilty of an offence.
Mandatory reporting requirements of any Police officer attending a death or suspected death must be reported to FACS are covered under the following sections of the Boarding Houses Regulation 2013.
Boarding Houses Regulation 2013 Regulation Reporting police attendances 27 1) The manager of an authorised boarding house must report to the Deputy Secretary the attendance of any police officer at the boarding house as soon as is reasonably practicable after the attendance if the reason for the attendance was to investigate an incident involving an additional needs resident.
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1.2 Application of Procedures: Table A
These procedures are mandatory for ADHC operated accommodation support services including centre-based respite services and other support services, unless otherwise stated. Some sections are mandatory for ADHC funded non-government support services and assisted boarding houses. They must be completed as part of the responding and reporting requirements under the service’s administrative processes.
AHDC funded Assisted boarding Section non-government house 1 Death of a person Mandatory Mandatory 1.1 Legal and legislative framework Mandatory Mandatory 2 Unresponsive person Mandatory Mandatory 2.1 Apply first aid and call an Mandatory Mandatory ambulance 2.2 Notify the next line manager Mandatory Mandatory 2.3 Attendance of ambulance Mandatory Mandatory 2.4 Admission to hospital Mandatory Mandatory 3 Deceased person Mandatory Mandatory 4 Response within 1 to 2 hours of Mandatory and adapt Mandatory and adapt the death to align with service’s to align with service’s processes processes 4.1 Notify management Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes 4.2 Notify next of kin or guardian Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes 4.3 Report the person’s death to Mandatory Mandatory NSW Police 4.4 Letters for NSW Police and Mandatory and adapt Mandatory and adapt State Coroner to align with service’s to align with service’s processes processes 4.5 Report death to Work Cover Mandatory Mandatory 4.6 Transportation of the deceased Mandatory Mandatory 5 Response within 24 to 48 hours Mandatory Mandatory 5.1 ADHC operated disability NA NA services 5.2 Other ADHC operated services NA NA
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AHDC funded Assisted boarding Section non-government house 5.3 ADHC funded non-government Mandatory NA services 5.4 Assisted boarding house NA Mandatory 5.5 Briefing note Mandatory NA 5.6 Attachments to the Briefing Mandatory Mandatory Note 5.6.1 Incident report form Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes 5.6.2 Client death notification form Mandatory Mandatory 5.6.3 Letter provided to State Coroner Mandatory Mandatory and NSW Police 5.6.4 Documentation Mandatory Mandatory 6 Response after 48 hours of Partial requirement Partial requirement death 6.1 ADHC operated NA NA accommodation services 6.2 Reporting to the NSW Mandatory Mandatory Ombudsman 6.3 Notifying internal FACS If applicable If applicable services 6.4 Notifying external services Mandatory Mandatory 6.5 Internal review of the death Mandatory and adapt Adapt to align with to align with service’s service’s processes processes 7 Responding to the NSW Mandatory Mandatory Ombudsman 7.1 ADHC operated disability NA NA services 7.2 ADHC funded non-government Mandatory Mandatory disability services and assisted boarding house 7.3 Strategic Change ADHC Mandatory Mandatory 8 Bereavement support Mandatory and adapt If applicable to align with service’s processes 8.1 Informing other people Mandatory If applicable 8.2 Supporting the family Mandatory If applicable 8.3 Supporting support workers Mandatory and adapt Adapt to align with to align with service’s service’s processes
Death Procedures, V1.1, November 2016 11
AHDC funded Assisted boarding Section non-government house processes 8.4 Supporting other people with Mandatory and adapt Mandatory and adapt disability to align with service’s to align with service’s processes processes 9 Post death requirements Mandatory Mandatory 9.1 Cultural and linguistic diversity Mandatory If applicable 9.2 Aboriginal and Torres Strait Mandatory Mandatory and adapt Islander people to align with service’s processes 9.2.1 Consent consideration and Mandatory Mandatory and adapt protocol to align with service’s processes 9.2.2 Ceremonies and practices Mandatory Mandatory and adapt to align with service’s processes 9.2.3 Notifying the family of the death Mandatory Mandatory 9.2.4 Support Mandatory Mandatory 10 Funeral arrangements Mandatory Adapt to align with service’s processes 11 Estate management Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes 12 The person’s bedroom and Mandatory and adapt Mandatory and adapt assets to align with service’s to align with service’s processes processes 13 Explanation of terms Observe Observe 14 Policy and practice contact If required If required details Flowcharts 1-3 Mandatory and adapt Mandatory and adapt to align with service’s to align with service’s processes processes
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2 Unresponsive person
When a person is found to be unresponsive or unusually unwell, the following steps must be followed.
2.1 Apply First Aid and call an Ambulance
If the person is not breathing, the support worker holding a current first aid qualification starts first aid and dials 000 to request an ambulance. If two people are on shift, one calls the ambulance while the other gives first aid. Continue first aid until the ambulance arrives. If the person has a current medically authorised Resuscitation Plan or Advance Care Directive, the caller must provide that advice when they dial 000.
2.1.1 Ambulance paramedics implementing Advanced Care Directives and authorised Resuscitation Plans The current NSW Ambulance protocols: • Do not support ambulance paramedics to follow instructions in a patient’s advanced care directive. • Allow ambulance paramedics to act on authorised Resuscitation Plans. Resuscitation Plans are plans developed in a hospital by an attending medical officer in consultation with the person or their person responsible. Refer to http://healthlaw.planningaheadtools.com.au/advance-care-plans-and- the-law/.
2.2 Notify the next Line Manager
A support worker at the scene notifies the relevant manager, the direct line manager, senior manager or on call manager (for after hours) of the situation.
2.3 Attendance of Ambulance
When the ambulance arrives, first aid responsibility is handed over to the attending ambulance officers. If the person has an Advance Care Directive and/or Resuscitation Plan, this is given to the ambulance officers as soon as they arrive to inform them of the person’s wishes regarding resuscitation. For further information about Advance Care Directives and Resuscitation Plans, refer to the End of Life Care Planning Guidelines in Volume 2 of the Health and Wellbeing Policy and Practice Manual and/or http://healthlaw.planningaheadtools.com.au/advance-care-plans-and-the-law/ .
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2.4 Admission to Hospital
If the person is admitted to hospital, notify the relevant manager, and the person’s family. Provide the hospital with the person’s Hospital Support Plan. Any disability support required by the person is negotiated between the hospital and ADHC, according to the Hospitalisation Guidelines and the person’s Hospital Support Plan (in Volume 2 of the Health and Wellbeing Policy and Practice Manual). If the person has any type of documentation about end of life care decisions, support is provided to ensure that the person’s wishes concerning end of life care are followed.
3 Deceased person
The person’s death is reported to the local police, and the caller advises the NSW Police that the death is reportable under the Coroners Act 2009 s24. If a person dies in their accommodation service the death is declared by the attending ambulance officers or a medical practitioner, if one is present. As far as possible the support worker ensures that the scene is unaltered. If the person dies after being admitted to a health facility such as a hospital or aged care facility, the accommodation support service manager must ensure that the doctor in charge is advised not to issue a death certificate (see Fact Sheet, Other resources). A death certificate can only be issued by the State Coroner.
4 Response within 1 to 2 hours of death
Refer to section 15 of these Procedures (page 36) for a flow chart of the immediate actions and response required within 1 to 2 hours of a person’s death.
4.1 Notify management
The death of the person must be reported to the manager or on call manager immediately. All deaths must be reported, regardless of the circumstances of the death, and including a person who died in a hospital or aged care facility. The Manager, Accommodation and Respite, or on-call manager, reports the death to the Director Disability Operations who notifies the relevant Executive Director Disability Operations or equivalent position. Senior management considers the circumstances and provides advice and support to the appropriate manager to complete the next steps, including
Death Procedures, V1.1, November 2016 14
notifying next of kin or guardian, the NSW Police and developing the briefing note to the Executive Director Disability Operations or equivalent (see Section 5.5). The Manager, Accommodation and Respite is the central point of contact and delegates areas of responsibility to the Coordinator Accommodation and Respite, and Team Leader as appropriate.
4.2 Notify next of kin or guardian
If the deceased person’s next of kin or guardian is not present at the time of death, the manager is responsible for notifying them of the death. While not always possible, notification is preferably done in person. Where the notification of the next of kin is given in person, the manager rings before coming over to see them, informs them a situation has occurred and they need to come and speak with them, and asks and whether they can arrange a support person of their choosing to be present whilst they have this discussion. Where the notification is done over the phone, the manager rings prior to inform the person that a situation has occurred and whether they could arrange a support person of their choosing to be present whilst they have this discussion. When an Aboriginal and Torres Strait Islander person dies, it is important to identify the senior member of the family to advise on matters surrounding the death, as it is a breach of cultural protocol to inform the family directly. This may also apply in other cultures and it is important to ask the family if there are any cultural protocols to be observed (see End of Life Care Planning Guidelines – Section 1.4 Cultural and Linguistic Diversity for more information) At the time of notification, the following information is provided by the manager: • when and where the person died (provide information about the circumstances of the death to assist the family to understand what has occurred in the case of an unexpected death) • that the death will be reported to NSW Police who will inform the State Coroner • that the death will be reported to the NSW Ombudsman. Refer to end of life care planning documentation the person has in place stating their preferences or wishes in the event of death. If the person does not have an end of life care plan, the manager will ascertain with the next of kin or guardian: • if they require an interpreter service • the need to observe any cultural or religious practices or taboos • whether the family or others wish to view the deceased person • a suitable time to view the deceased person before transportation to the State Coroner. Alternatively, viewing times may be arranged with the State Coroner or funeral director.
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The person’s family and friends may choose to visit the house to view the person’s bedroom and belongings. To facilitate this, ensure the person’s bedroom and belongings remain how they were left.
4.3 Report the person’s death to NSW Police
The manager ensures that the person’s death is reported to the local NSW Police, and they understand that the death is reportable under the Coroners Act 2009 s24. The manager is to: • ensure that the name, rank and station of the attending NSW Police officer is recorded and retained by the service • organise support for another person with disability if the NSW Police indicate they wish to interview this person. Support includes an advocate or person of their choice, and if necessary, legal representation • confirm who will identify the person to the NSW Police, that is family, a friend, the manager, or an ADHC employee who knows the person. If the NSW Police wish to interview an ADHC support worker, contact ADHC FACS Legal for assistance, or if outside business hours, the on call manager. Note: The manager of an Assisted Boarding House is required under the Boarding House Act 2012 to inform FACS as soon as is reasonably possible (preferably within 24 hours), about the death of a person from an Assisted Boarding House, as outlined in the Assisted Boarding House Authorisation and Monitoring Manual.
4.4 Letters for NSW Police and State Coroner
Unit managers are to ensure that standard letters are sent notifying the NSW Police and the State Coroner of the person’s death. A different letter is required if the person was temporarily absent from their residence at their time of death (see Tools and templates). The manager is to: • retain copies of the completed letters • hand over the original letters for the State Coroner and NSW Police to the attending Police Officer and request that they be lodged with the State Coroner when the deceased is transported to the morgue. When a person is temporarily absent at their time of death, for example, in a hospital, or aged care facility or staying with family or friends, the manager completes the letters. The manager immediately informs the relevant person, where the deceased was staying at the time of death, that the death is reportable. The manager can then complete the letters for that person to give to the NSW Police when the deceased is transported to the morgue.
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4.5 Report the death to WorkCover
The Work Health and Safety Act 2011 (WH&S Act 2011) require the regulator (WorkCover) to be notified immediately of deaths and serious incidents which occur in the workplace. Serious incidents can be serious illnesses or serious injury of a person, dangerous incidents (an incident that exposes a worker or any other person to a serious risk to health or safety) or the death of a person arising out of work carried out by a business undertaking or workplace. This includes all deaths or serious injuries to people living in an ADHC operated or funded non- government support service, or in an Assisted Boarding House. The WH&S Act 2011 also requires the site of the incident to be preserved until an inspector arrives or directs otherwise (subject to some exceptions). If a person dies in an ADHC operated or funded non-government support service, or an Assisted Boarding House, the manager responding to the death must report the death to WorkCover at the same time as they report the death to the NSW Police. The WorkCover officer responding to the phone call will ask the manager the following of questions about the incident: • a description of what happened • when it happened • where it happened • who was involved • the legal and trading name of the ADHC operated or funded non- government service, or Assisted Boarding House • whether the NSW Police have been contacted and are attending the scene • whether the body of the deceased will be transported to the State Coroner • the name of the manager notifying WorkCover. If the manager is unable to provide all of the information requested at the time of notification, the remaining information will be collected by WorkCover at a later time. After the phone call, the manager is to document: • the time they notified WorkCover • the name of the WorkCover officer they spoke to • advice or directions provided by the WorkCover officer during the phone call. This information will be required for a briefing note to the Executive Director Disability Operations or equivalent.
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The manager is responsible for ensuring that the site where the incident occurred is left undisturbed, so far as possible. An incident site may be disturbed however to: • assist an injured person • remove a deceased person • facilitate a Police investigation • make the site safe or to minimise the risk of a further ‘notifiable incident’ • follow direction given either in person or by telephone by a WorkCover officer. Refer to flowchart 1 of this document and to the WorkCover Fact Sheet – Incident Notification (see Tools and templates) or for further advice on notifiable incidents contact NSW WorkCover on 131050.
4.6 Transportation of the deceased
The NSW Police are responsible for placement of an identification tag and arranging transportation of the deceased person to the State Coroner.
5 Response within 24 to 48 hours of death
Refer to section 15 of these Procedures (page 37) for a flow chart of the following actions required within 48 hours of a person’s death (flow chart 2).
5.1 ADHC operated accommodation support services
In all ADHC operated accommodation support and centre-based respite services, the person’s death is classified as either expected or unexpected, depending on the circumstances (see Section 13). In both cases the manager completes a Client Information System (CIS) Incident Report form either electronic or paper version (see FACS Incident Reporting and Management Policy and Guidelines for people accessing Ageing and Disability Direct Services, November 2014) and enters it in CIS. • Unexpected Death – Category 1 Report • Expected Death – Category 2 Report. Where the death was unexpected, ADHC staff are to follow these procedures and prepare the briefing note and attachments to the Executive Director Disability Operations or equivalent (see section 5.5).
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5.2 Other ADHC operated services
When a person dies unexpectedly in an ADHC operated disability support service, other than an accommodation support service or centre-based respite, a Category 1 Incident – Executive Briefing Form (see Tools and templates) is completed and scanned and emailed to Deputy Secretary Disability Operations at [email protected] and [email protected] Refer to the FACS Incident Reporting and Management Policy and Guidelines for people accessing Ageing and Disability Direct Services, November 2014 for assistance when completing the Category 1 Incident – Executive Briefing Form for an unexpected death. In all ADHC operated accommodation support and centre-based respite services, whether the death is expected or unexpected, the manager prepares and forwards a Briefing Note and attachments to the Executive Director Disability Operations or equivalent.
5.3 ADHC funded non-government disability support services
Within 24-48 hours of the death of the person, ADHC funded non-government support services are to provide verbal advice of the death to the Executive Director Disability Operations or equivalent in their District. ADHC funded non-government support services are required to complete a briefing note and attachments (see below sections 5.5 and 5.6.1-4). The documents are scanned and emailed to Deputy Secretary Disability Operations at [email protected] Assisted Boarding Houses ADHC staff or staff of ADHC funded non-government support services are to advise the manager of an Assisted Boarding House that, on the death of a person living in their service, the Client Death Notification form contained in the Assisted Boarding House Practice Guide is to be completed and emailed to Deputy Secretary Disability Operations at [email protected] as soon as is reasonably possible, preferably within 24 hours.
5.4 Briefing Note
The content of the Briefing Note to the Executive Director Disability Operations or equivalent and for funded non-government disability services to the Deputy Secretary should include the following information: • the person’s name, date of birth, address • date of death
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• whether the death was expected or unexpected • if an expected death, the person’s diagnosis (if known) • length of time at facility • contact details of ‘next of kin’ or guardian • record of contact with ‘next of kin’ or guardian • record of contact with the NSW Police and/or State Coroner • record of contact with WorkCover and the advice provided • communication assistance • general medical issues • medication • identified disabilities • mobility • height and weight • events surrounding an unexpected death and police advice.
5.5 Attachments to the Briefing Note
5.5.1 Incident Report Form The Incident Report Form is completed by a support worker and the manager who was notified at the time of the person’s death. Information for completing the Incident Report Form can be found in the FACS Incident Reporting and Management Policy and Guidelines for people accessing Ageing and Disability Direct Services November 2014. The Incident Report Form is completed in either electronic or paper format. ADHC funded non-government services will use their services’ incident report form.
5.5.2 Client Death Notification Form (CDN) The CDN form is available on the ADHC intranet, and on the Service Provider Portal for ADHC funded non-government accommodation support services and assisted boarding houses.
5.5.3 Letter provided to the State Coroner and NSW Police ADHC operated and funded non-government accommodation support services are to attach copies of the letters written to the NSW Police and the State Coroner (see Tools and templates) to the briefing note.
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5.5.4 Documentation Copies of specific documentation relating to the deceased person are required in their most current format. This documentation includes the person’s: • Nutrition and Swallowing Risk Checklist • Mealtime Management Plan, if applicable • Enteral Nutrition Plan, if applicable • My Health and Wellbeing Plan or any other health care plan • Lifestyle Plan • plans for chronic and other health conditions for example epilepsy, asthma, diabetes, bowel care, and respiratory management • My Safety Profile and My Safety Plan • Behaviour Support Plan, if applicable • Palliative Care Plan or other treatment plan, if applicable • any document that has been developed by the person, with the person or on behalf of the person that contains end of life care decisions, including Advance Care Directives or Resuscitation Plan, if applicable.
6 Response 48 hours after death
6.1 ADHC operated accommodation support services
The Executive Director Disability Operations or equivalent, endorses the briefing note, incident report and attachments and forwards the documents to the Deputy Secretary Disability Operations at [email protected] . If the death is unexpected, a copy of the briefing note, incident report and attachments is sent to FACS Legal for information. The Performance Improvement Unit forwards all briefing notes and attachments to the NSW Ombudsman to notify of the person’s death.
6.2 Reporting to the NSW Ombudsman
When a person dies in an accommodation support service (funded non- government or operated by ADHC), centre-based respite service, or an Assisted Boarding House, it is mandatory to report the death to the NSW Ombudsman through the Performance Improvement Unit using the CDN form. Section 7 of these Procedures provides guidance for responding to the NSW Ombudsman following the death of a person from a disability service.
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6.3 Notifying internal FACS Services
The manager informs relevant FACS business areas of the death of the person. This can either be done verbally or in writing. Business areas and systems that may require notification include: • Aids and Equipment in Supported Accommodation (AESA) Committee to return items purchased through this scheme to the AESA aids and equipment pool • Business Services to cancel residency charges • internal therapy appointments • CIS to register the date of death of the person.
6.4 Notifying external services
The Manager informs relevant external services of the death of the person. This can either be done verbally or in writing, depending on the requirements of the external service. External services that require notification include: • day / work program • financial Institutions and managers • NSW Trustee and Guardian (formerly known as the Office of the Protective Commissioner) for people under banker arrangements, or for people under financial guardianship • dentist • doctor • allied health professionals • health fund - Medicare • clubs/groups and • subscriptions. The death certificate may be required as evidence of the person’s death when notifying external services.
6.5 Internal review of the death
The NSW Ombudsman requires ADHC to conduct an internal review following the death of a person. Districts must review all deaths whether the person was at their usual residence or temporarily absent, for example in hospital, visiting family, on holidays or in the community. All reviews must be conducted in
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accordance with the ADHC Operational Guidelines for the Review of the Death of People with Disability. The review process is documented and the outcome, including recommendations, are recorded as required in the Operational Guidelines for the Review of the Death of People with Disability and submitted to the relevant Executive Director Disability Operations and to Deputy Secretary, Disability Operations.
7 Responding to the NSW Ombudsman
The NSW Ombudsman is concerned with systemic issues and how deaths might be prevented. The Ombudsman specifically: • monitors and reviews deaths of people with disabilities and certain children to identify patterns and trends • analyses the circumstances of reviewable deaths, and makes recommendations for reviewing policies and practices relating to the support and safety of children, and people with disabilities • creates and maintains a register of reviewable deaths in NSW • undertakes research and projects focusing on strategies to reduce or remove risk factors associated with deaths that are preventable • tables a report relating to reviewable deaths to the NSW Parliament every two years. The protocol for responding to a complaint or request for information from the NSW Ombudsman depends on whether the subject is an ADHC operated or funded non-government disability service, or an assisted boarding house. Flow chart 3 and the following sections outline the responsibilities of all disability service providers when responding to the NSW Ombudsman (section 15, page 38). Note that in addition to requests for information from the NSW Ombudsman, ADHC operated and funded non-government services may also receive requests for information from the State Coroner. Requests from the State Coroner are referred to FACS Legal for action at [email protected].
7.1 ADHC operated accommodation support services
If the Ombudsman’s request is about an ADHC operated accommodation support service it will be managed by the Performance Improvement Unit. The Performance Improvement Unit will forward the documents to the relevant Executive Director Disability Operations , with a copy sent to FACS Legal. The Performance Improvement Unit will liaise with the relevant Executive Director Disability Operations and arrange for the request to be investigated, and can
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seek advice from FACS Legal about the information the District is legally required to provide. The response is submitted to the Deputy Secretary, Disability Operations. Copies of all original documents are to be retained in a temporary file at the service where the deceased person resided.
7.2 ADHC funded non-government disability support services and Assisted Boarding Houses
When the NSW Ombudsman requests information about a reviewable death, the ADHC funded non-government disability support service or Assisted Boarding House is required to provide a response to the Executive Director Disability Operations or equivalent by the due date. If the Executive Director Disability Operations or equivalent receives correspondence directly from the NSW Ombudsman about an ADHC funded non-government disability support service or Assisted Boarding House, the Executive Director Disability Operations, an equivalent or a delegated person, refers the correspondence on to the funded service or the Assisted Boarding House. The funded non-government disability support service or Assisted Boarding House provides a response, which must be endorsed by a senior manager of the funded service, or the licensee of the Assisted Boarding House, and sends it to the Executive Director Disability Operations or equivalent. The appropriate District manager drafts the following documents to accompany the response to the Ombudsman: • an assessment of compliance with ADHC policy, conditions of funding agreement or in the case of Assisted Boarding House, the Boarding House Act 2012, Boarding Houses Regulation 2013 or Conditions of License (legal advice can be sought from FACS Legal to help with this assessment) • the original response provided by the funded service or the assisted boarding house. Copies of these two documents are marked confidential, flagged as a Reviewable Death Matter and forwarded to the Executive Director Disability Operations or equivalent position. In the case of an Assisted Boarding House, it may also be appropriate to provide a copy to the Executive Director who has oversight of Boarding House Compliance Officers. The Executive Director Disability Operations or equivalent position should then forward these documents to the Deputy Secretary Disability Operations at [email protected]. Copies of all original documents requested by the Ombudsman are to be retained in a temporary file at the service where the deceased person resided.
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7.3 Performance Improvement Unit
All correspondence received from the NSW Ombudsman relating to the death of a person who receives an ADHC accommodation support service or centre- based respite service is managed by the Performance Improvement Unit [email protected]. The Performance Improvement Unit registers the correspondence on TRIM and links it to the CDN TRIM number. The Performance Improvement Unit forwards all correspondence from the NSW Ombudsman to the Executive Director Disability Operations or equivalent of the District where the deceased person resided. To ensure that FACS Legal is aware of ongoing inquiries, the Performance Improvement Unit also sends copies of requests for information from the Ombudsman, and responses from ADHC to the Ombudsman’s inquiries, to FACS Legal ([email protected]).
8 Bereavement support
Grief is a normal response to loss and can occur at any time, even before the person dies. People experiencing grief are often supported by family and friends and sometimes external support is needed.
8.1 Informing other people
The line manager should ask the family’s consent to inform others about the person’s death and how they would like it done. Others might include: • people who lived with the person • friends and support workers at day programs • work colleagues at the person’s place of employment • community groups that the person is involved with.
8.2 Supporting the family
In consultation with the family, an employee of an operated or funded non- government can make a referral to the Beareavment Care Centre or a bereavement care service that is available in the local area for bereavement counselling services (see Other resources). Bereavement counselling is available from many organisations, such as places of worship e.g. church, synagogue, temple etc., registered psychologists, or services such as Lifeline or Barnardo’s etc. Talk with the family to find out if they require bereavement counselling and if so, what type of service they would prefer.
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Consideration should be given to families and others in the event of the death of their loved ones, including: • responding in a prompt and dignified manner • respecting and being sensitive to cultural and religious beliefs and practices of the person and family • ensuring the deceased person’s bedroom is left intact so that the family, friends and support workers have the opportunity to visit the bedroom • assisting with funeral preparations where possible (see Section 10) • maintaining contact with the family after the funeral, this is especially important if family were actively involved in activities at the disability service, and had formed relationships with other people with disability, their families and support workers • providing relevant information to the family where action has been taken to improve service as a result of the death of their family member.
8.3 Supporting support workers
The loss of a person also affects support workers. They often have a difficult time dealing with their loss, and it is the managers’ responsibility to support them through this process. An individual counselling or group debriefing may be beneficial, as well as giving support workers the opportunity to talk about how they are feeling immediately after the event and over time. Debriefing can be done by managers organising an informal discussion amongst the team in a supportive, safe and accepting environment, or by formal debriefing with a skilled counsellor. In ADHC operated accommodation support services, formal debriefing or individual counselling is available for individuals and teams through the Employee Assistance Program on telephone 1300 687 327. This is a free service provided by registered psychologists.
8.4 Supporting other people with disability
Arrangements can be made, where required, for the bereaved person/s to receive support with communication and bereavement counselling. This may include making a referral to allied health specialists such as a psychologist for counselling. A speech pathologist can develop communication aids such as social stories to assist the bereaved person to understand and cope with the death of the person. There are resources available to support workers in considering how they can work best with others who are affected by a death. When assisting a person with disability to deal with grief and loss, support workers should consider the following points:
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• be honest, include and involve the person • listen, and be present for the bereaved person • actively seek out nonverbal rituals • respect photos and other mementos the bereaved person may have • minimise changes in routine, accommodation or caregivers • assist searching behaviour • support the observance of anniversaries • seek specialist help if behavioural changes persist. There are resources that support workers can use to support other people with disability to help them deal with the death of their friend (see Other resources).
9 Post death requirements
9.1 Cultural and linguistic diversity
Cultural sensitivity is important at this time. Around one in three NSW residents were born overseas, and one in five speaks a language other than English. Each person and family is unique. A culture and language assessment may be needed to establish the family’s requirements after death. If an interpreter is required, refer to the ADHC Language Service Guidelines (see Other resources). It is important to know if the deceased person and the family had developed an end of life care plan, before any arrangements are made. If end of life planning was done, confirm with the contact person that they want to implement the plan as it is, or make some changes. If end of life planning was not completed, even if the family is making its own funeral arrangements, it is important to establish if they have any rituals, ceremonies or taboos around the death of a person. The manager or a delegate can seek information from the family about the following: • the spiritual and religious beliefs, practices and taboos they wish to observe • how the person and the family communicate, such as the need for an interpreter, or the acceptability of certain words when discussing illness and dying • which member of the family or community is the contact person for problem solving and decision making, and the particular roles the family and community members have after the person dies.
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9.2 Aboriginal and Torres Strait Islander People
Aboriginal and Torres Strait Islander people have a number of customary practices at the time before death, when the person dies, and following death. Each family and community is unique, and this is dependent on his or her links and experiences. It cannot be assumed that all people follow the same practices. Significant impacts for Aboriginal and Torres Strait Islander people around death are included below however are not limited to the following.
9.2.1 Consent considerations and protocol Culturally appropriate consent Ask the person and their family member who in the family is the contact person to discuss issues around death and who provides consent. Record the name(s) and their roles and contact details on the person’s records. Issues of a sensitive nature and practices that are taboo Ask the person and their family member to explain what issues around death and dying are sensitive. Record this information on the person’s records.
9.2.2 Ceremonies and practices Ceremonies and practices around the death and dying Ask the family what and when they perform the ritual or practice. Record these ritual and/or practices in the person’s records so support workers are aware. Family and friend roles and responsibilities around death practices and ceremonies. Ask the person and/or their family who will be involved in the practice and/or ceremony. Record this information on the person’s records. The gathering of the family is part of the ceremony to help the spirit leave the person and move away. When the family gathers, the extended family gatherings may be large, and requires enough space and privacy and time for this to occur. Use of images and naming of the deceased Saying the person’s name or the putting up photos of the person is taboo as some Aboriginal and Torres Strait Islander people believe that it calls the spirit back.
9.2.3 Notifying the family of the death Cultural protocol for notifying the designated family member It may be inappropriate for a non-Aboriginal person known or unknown to the family to discuss any issues about the person and the death with the family member directly.
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The time of death is very significant for Aboriginal and Torres Strait Islander people. Cultural protocol is extremely important at this time. The designated family member must be contacted by the nominated service representative or an Aboriginal Liaison Officer. Coronial inquests may interfere with the practice of taking the deceased back to their land. Where possible, the family must be informed in advance that it is required by law everyone for receiving a disability service (even if they are absent at the time of death for example in a hospital or at the family home) to be the subject of a coronial enquiry. This will not stop the family’s rituals however it may delay some aspects. The way a person dies has different meanings for Aboriginal and Torres Strait Islander people. A sudden and unexpected death has a very different meaning to a slow and expected death.
9.2.4 Support When a person is accessing a service such as a hospital ask if they would like a referral to the Aboriginal Liaison Officer. If so, record this in the person’s records and support the person and their family member to access this service. Funding barriers may occur with the rituals the family wishes to practice, for example, gathering of the family, taking the body back to their land or the cost of the funeral. Discuss these issues with the designated family representative and refer the person, or support them to access Burial Assistance funding. For information and financial assistance regarding funeral services, the NSW Aboriginal Lands Council can also be contacted. Loss and grief support. If the family has access to an Aboriginal Liaison Officer they will ensure they are receiving support. (See Other resources for alternative support options). Where possible it is be best practice to contact Aboriginal Liaison Workers or Community Workers to assist with planning and preparation for the funeral and associated ceremonies.
10 Funeral arrangements
Families are generally responsible for arranging the funeral. If the person has a Lifestyle Plan or end of life care plan that outlines the person’s or the family’s funeral wishes, this should be followed. If the deceased does not have a family, guardian or advocate, support workers are responsible for arranging the funeral and advising friends, work associates, day placement, recreation services and service providers of the death of the person and the funeral arrangements. In cases where the family cannot afford the cost of the funeral, and the person’s estate cannot cover funeral costs, the manager can make a referral to the local Police and/or the NSW Aboriginal Lands Council for information and financial assistance.
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If the unit Manager contacts the NSW Aboriginal Lands Council, the Manager has responsibility to oversee the process. If the Manager makes a referral to the local police, the NSW Police are responsible for contacting the NSW Ministry of Health for financial assistance with burials and cremations for a person without means. The NSW Police advise the funeral director of the person’s death and that it is a destitute burial. The NSW Police complete the appropriate forms and forward them to the NSW Ministry of Health along with the funeral director’s invoice. The NSW Ministry of Health arranges payment to the funeral director. The line manager supports the person’s peers and other support workers to attend the funeral and may: • liaise with families about funeral arrangements • transport other people with disability to and from the funeral and post- funeral gathering • consider the option of other people with disability and support workers to view the deceased person if this is available and applicable • provide, and organise for communication tools and strategies to be developed to assist other people with disability to understand what to expect at the funeral.
11 Estate management
In cases where the person does not have a will, the manager will seek direction from the NSW Trustee and Guardian. If the person made a will, the person’s solicitor and Executor manage the closure of any financial business on behalf of the person. For ADHC operated accommodation support services and other services refer to the Personal Finance Procedures - estate management for further information. ADHC staff can seek further advice from FACS Legal if they are unsure about estate management for a person who was receiving ADHC services.
12 The person’s bedroom and assets
The deceased person’s belongings are to be secured by closing or, if possible, locking the person’s door. If any of the deceased person’s possessions are elsewhere in the house they are returned to the person’s room. Nothing is to be removed from the person’s bedroom until after the NSW Trustee and Guardian or Executor has given instructions. Support workers are not to clean the bedroom or change it in anyway. After the death, the parents and family may wish to spend time in the person’s room as part of their grieving.
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After the funeral the manager will be required to complete an asset stock take against the existing asset register. When the stock take has been completed the person’s assets are placed in a secure storage facility until instructions are given by the NSW Trustee and Guardian or the Executor of the will. A copy of the asset register is placed in storage with the deceased person’s possessions. If the person has a will, the original copy is placed on the person’s file and a copy is provided to the solicitor.
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13 Explanation of terms
Term Explanation Accommodation This term refers to Large Residences, Specialist Supported support Living centres, Assisted Boarding Houses, group homes, services centre-based respite and in-home support for ADHC operated and funded non-government accommodation support services. Advance Care An ACD records the person’s preference for future care and Directive (ACD) appoints a substitute decision-maker to make decisions about health care, and personal life issues management. ACDs have legal status and are recognised under the law. The ACD comes into effect when the person loses the capacity to make decisions e.g. the person is in a coma. In NSW an ACD usually contains details of a person’s health management preferences: • any values and beliefs that may guide future treatment instructions regarding the future use or restriction of particular medical treatments • details of who the person wants to make decisions for them when they are no longer able. Advance Care An advance care planning discussion will often result in an Plan (ACP) ACP. The ACP records the person’s preferences about health and preferred outcomes. It may be developed on the person’s behalf, and is prepared from the person’s perspective to guide decisions about treatment and care. It may be verbal or written. It should inform a Resuscitation Plan or Palliative Care Plan. Assisted Under Section 37 of the Boarding Houses Act 2012, an Boarding House assisted boarding house is: • a boarding house premises that provide beds, for a fee or reward, for use by 2 or more residents who are persons with additional needs • a boarding premises that are declared to be an Assisted Boarding House by a notice in force under section 39 of the Act.
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Term Explanation Bereavement, The support provided to people who are experiencing bereavement bereavement or grief following the death of a significant support and person. counselling Bereavement is the response to a loss and includes the process of ‘recovery’ or healing from loss. Each person will grieve and recover in his or her own way. Bereavement counselling is provided to people who have experienced the death of someone close to them. Client Death The CDN form is to be completed as a mandatory Notification requirement of ADHC funded and operated accommodation (CDN) form support services, and Assisted Boarding House, to notify the Ombudsman of the death of a person. Child A person under the age of 18 years (as per Section 24(3) of the Coroners Act 2009). Conditions of The set conditions or requirements prescribed to an assisted License boarding house with which they are legally required to comply. Each Assisted Boarding House has a set of conditions that are issued in accordance with the Boarding Houses Act 2012 and the Boarding Houses Regulation 2013. CS CRAMA Community Services (Complaints, Reviews and Monitoring) 1993 Act 1993 Performance When an unexpected death occurs, PI oversees the internal Improvement review process and provides advice as required. PI is (PI) Unit responsible for liaising with the NSW Ombudsman on the death of a person including providing their office with copies of the relevant reports. PI also has a lead role in responding to systemic recommendations through remedial actions and identifying opportunities to prevent and respond to deaths of people with disability in ADHC operated accommodation and centre-based services. End of life care End of life care planning is a process of planning for future planning care whereby the person’s values, beliefs and preferences are made known, so they can guide decision-making at a future time when the person is unable to make or communicate decisions. This allows the person to choose the type of care and support to live and die well in their preferred place. The planning process allows the person with disability to understand dying and death, as part of a natural cycle of life and to develop self determined wishes. Where a person has limited capacity to make decisions, families can assist the person to make plans through supported shared planning.
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Term Explanation Expected death An expected death is when a person has a progressive, advanced disease or terminal illness, or the person chooses not to pursue curative treatment. Health Care A plan prescribed by a health professional such as the Plan person’s usual general practitioner which outlines advice, recommendations and timeframes for the completion of health actions for the person. In ADHC operated accommodation support services, the health care plan is known as the My Health and Wellbeing Plan. Lifestyle Plan A ‘living’ plan that belongs to the person and which represents the person’s wishes and lifestyle choices. The Lifestyle Plan includes an Action Plan which describes all the actions that are needed to help the person achieve their goals and dreams. Mandatory The CS CRAMA requires reviewable deaths to be reported to reporting the NSW Ombudsman. The Coroners Act 2009 requires certain deaths or suspected deaths to be reported to the NSW Police and State Coroner. Manager In ADHC operated disability services this term refers to Team Leaders, Coordinators Accommodation and Respite, Registered Nurse Unit Managers, Nurse Manager Accommodation and Nursing Services, and any manager in the reporting line. Ombudsman The NSW Ombudsman is an impartial watchdog who is independent of the government of the day and accountable to the public through the NSW Parliament. The Ombudsman carries out his role under the Community Services (Complaints, Reviews and Monitoring) Act 1993, Ombudsman’s Act 1974 and the Commission for Children and Young People Act 1998. The Ombudsman’s role includes reviewing the deaths of certain children, young people and people with disabilities in care (called ‘reviewable deaths’). End of Life Care A written plan developed with the person, the family or Plan guardian, the person responsible and the services involved in providing care to the person. The End of Life Care Plan is a person centred approach to planning the person’s care. It aims to support the person, their person responsible and family or guardian, to direct and influence the person’s treatment and quality of life.
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Term Explanation Person A person responsible is someone who has the authority to responsible consent to medical or dental treatment for an adult who is unable to give or refuse consent for their own treatment. As stated in the Guardianship Act 1987, a ‘person responsible’ only exists where the person is unable to give informed consent. The person responsible is not necessarily the person’s next of kin. There is a hierarchy of people who can be the person responsible. Refer to the Decision Making and Consent Policy (in the ADHC Lifestyle Policy and Practice Manual) for information on the person responsible. Police The NSW Police attend the death of a person under the care of an accommodation support service even if at the time of the death the person was temporarily absent from their usual residence, such as, in hospital. The NSW Police are required to place an identification tag on the body and report the death of a person with disability to the State Coroner. The NSW Police are also required to arrange transport of the deceased to the State Coroner. Resuscitation A Resuscitation Plan is a medically and legally enforceable, Plan (previously authorised order to use or withhold resuscitation measures, known as No and documents any other time critical clinical decisions CPR Orders) related to end of life. For more information and template see Other resources – Resuscitation Plans in End of Life Decisions – NSW Health. Reviewable The Reviewable Disability Death Team within the Community Disability Death Services Division of the NSW Ombudsman. Team State Coroner The State Coroner considers each death to determine the manner and cause of death and to decide whether an inquest is necessary. Section 36 of the Coroners Act 2009 requires the State Coroner to inform the NSW Ombudsman about certain child or disability deaths. These requirements are in addition to the requirements of Part 6 (‘reviewable deaths’) of the CS CRAMA. Senior Manager In ADHC this refers to the manager who has the authority to act in a given situation. TRIM FACS’ current document tracking system. Unexpected An unexpected death is when a person dies suddenly and death unpredictably.
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14 Policy and Practice Unit contact details
You can get advice and support about this Policy from the Policy and Practice Unit, Contemporary Residential Options Directorate.
Policy and Practice Unit Contemporary Residential Options Directorate ADHC [email protected]
If you are reviewing a printed version of this document, please refer to the Intranet to confirm that you are reviewing the most recent version of the Policy. Following any subsequent reviews and approval this policy will be uploaded to the internet/and/or intranet and all previous versions removed.
Death Procedures, V1.1, November 2016 36
15 Index of flowcharts
Flow chart 1: Immediate action and response required within 1 to 2 hours of a person’s death
IMMEDIATE ACTION if person is found unresponsive
All services: ADHC operated and funded accommodation support services; Assisted Boarding Houses
Apply first aid and call 000 for an Ambulance. Refer to the person’s Advance Care Directive / Acute Resuscitation Plan (if applicable) If the person is resuscitated refer Notify your line manager to advice of: (or on call manager) - Ambulance officer - Medical practitioner Continue first aid until Ambulance arrives. Hand over to Ambulance Officers Refer to information outlined in the person’s - Health care plan DEATH IS DECLARED by Ambulance -End of life, Palliative Care, Officer or Medical Practitioner if present Advance Care or Treatment Plans - Hospital Plan
RESPONSE WITHIN 1 - 2 HOURS
Manager of all services notifies next of kin Manager of an Assisted Boarding or guardian Houses reports the matter to the Police and FACS as soon as reasonably possible (i.e. within 24 Manager of ADHC operated and funded hours). services calls local Police to attend to the Manager to report to FACS the death in all circumstances attendance of any police officer at the boarding house to investigate Manager of all services notifies the death as soon as reasonably WorkCover on 13 10 50 possible (i.e. within 24 hours).
ADHC operated disability services
Local Police make arrangements Manager completes letters for Police and to transport the deceased to the State Coroner State Coroner
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Flow chart 2: Action required when the NSW Ombudsman submits a complaint or requests further information
NSW Ombudsman Submits complaint and / or request for further information
Deputy Secretary Disability Operations Corresponds directly with the NSW Ombudsman
Deputy Secretary Disability Operations Corresponds with the District Director or equivalent position
District Director Forwards and receives correspondence with the relevant service
ADHC funded support ADHC operated support services Assisted Boarding Houses services ▪ Assesses allegations or ▪ Assesses allegations or ▪ Investigates allegations or concerns raised concerns raised concerns ▪ Provides a proposed ▪ Provides a proposed ▪ Provides a proposed response to the District response to District Director response to the District Director by the due date by the due date provided Director provided ▪ Retain copies of original ▪ Retain copies of original ▪ Retain copies of original files at the services at the files at the service at which files at the services at the which the deceased person the deceased person resided which the deceased person resided resided
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Flow chart 3: Action required within 48 hours of a person’s death
ACTION WITHIN 48 HOURS OF A PERSON’S DEATH
Children, young people and adults Assisted Boarding Houses receiving ADHC operated support Children, young people services and adults receiving ADHC funded support Refer to the Assisted services including Boarding Houses accommodation support, Authorisation and respite, community Monitoring Manual access programs
Accommodation Other disability support and respite services e.g. e.g. group homes; Large Community Support Residential Centres; The Manager informs Teams; community Specialist Supported the District Directoror access programs Living; centre-based equivalent of the death respite of the person.
Unexpected Expected Procedures may be death death adapted or adopted according to organisational and operational structure.
The District Director endorses the Briefing Note and Incident Report, CDN form and all relevant attachments and faxes to FACS Performance Improvement Refer to funded organisational procedures for additional information
If death is unexpected and / or unexplained FACS Performance Improvement forwards Briefing Note and Incident Report to the Deputy Secretary Disability Operations for review and endorsement
FACS Performance Improvement forwards Briefing Note, Incident Report CDN form and all relevant attachments to the NSW Ombudsman and Law & Justice not later than 30 days after receipt of advice
The NSW Ombudsman responds to the death of the person to FACS Performance Improvement and requests further information to be provided
Death Procedures, V1.1, November 2016 39
Language Services Guidelines
Version 1.2
Community Access Ageing, Disability and Home Care Department of Family and Community Services NSW May 2012
Final
Document approval
The Language Service Guidelines has been endorsed and approved by:
Jim Moore Lauren Murray Chief Executive, ADHC Deputy Director-General, ADHC Approved: 24 September 2010 Approved: 24 September 2010 Signature on file Signature on file
Document version control
Distribution: All ADHC
Document name: Language Services Guidelines
Version: Version 1.2
Document status: Final
File name: Language Services
Authoring unit: Community Access
Date: May 2012
Version 1.2 Updated May 2012 Table of contents
1 Language Services Guidelines ...... 1 1.1 Guidelines for Using Interpreters ...... 1 1.1.1 The Role of an Interpreter ...... 1 1.1.2 Styles of Interpreting...... 2 1.1.3 Critical Points when an Interpreter should be used...... 2 1.1.4 Accredited on-site interpreters...... 3 1.1.5 Procedure for booking an interpreter...... 4 1.1.6 Working with an on-site interpreter...... 6 1.1.7 Accredited telephone interpreting...... 7 1.1.8 Procedure for making a complaint about an interpreter ...... 8 1.1.9 Interpreting Services...... 9 1.2 Guidelines for Using Translated Information...... 11 1.3 Guidelines for Accessing and Using Bilingual Staff ...... 14 1.3.1 Community Language Allowance Scheme (CLAS) – ADHC Only...... 14 1.4 Translated Glossaries ...... 17 2 Appendices ...... 18 Appendix 1 – Decision tree 1: using an interpreter...... 19 Appendix 2 – Decision tree 2: when a client refuses to use an interpreter ...... 20 Appendix 3 – Decision tree 3: when an interpreter is not available ...... 21 Appendix 4: – Explanation of Terms...... 22 Appendix 5: – Interpreter and Translator Accreditation Levels ...... 24 Appendix 7 – CLAS Recipient Worksheet ...... 27 Appendix 9 – Aboriginal languages...... 29 Appendix 10 – Community languages by Country...... 30
Version 1.2 Updated May Error! Reference source not found.
1 Language Services Guidelines
New South Wales is one of the most culturally, linguistically and religiously diverse states in Australia, and diversity is a defining feature of ADHC’s client base. A proportion of clients will require language assistance in their attempts to access services. To ensure equitable access to services and programs, ADHC is committed to the development and implementation of practical communication strategies. The Language Services Guidelines have been developed as a tool to facilitate the implementation of the Language Services Policy by ADHC staff. The Guidelines are also relevant to ADHC funded agencies, who are encouraged to utilise them to guide and develop their practice and systems for the use of language services. ADHC’s Language Services Policy was developed to support ADHC staff in direct communication with clients from culturally and linguistically diverse backgrounds, their families and significant others. The Policy is the foundation for effective and accessible communication, and the development of a service system which will build staff capacity to work cross culturally. Through the Community Relations Commission and Principles of Multiculturalism Act 2000 the NSW Government is committed to ensuring that linguistic needs of all clients are addressed, and this requirement extends to all contracted and funded services. The Guidelines will be a useful aid in determining how this responsibility may be met. 1.1 Guidelines for Using Interpreters The following provides guidelines for working with both: accredited on-site interpreters in Auslan and community languages accredited telephone interpreters who can be accessed via the use of telephone, speaker phones, conference call, video conferencing.
1.1.1 The Role of an Interpreter Interpreters are used to provide a clear channel of communication, not to provide direct counselling or advice to the client or to a staff member. They are bound by strict codes of conduct and ethics known as ‘The Australian Institute of Interpreters and Translators Code of Ethics’ to ensure a high level of integrity and professionalism. Common standards include: impartiality and confidentiality disclosure of conflicts of interest accuracy and competence honesty, integrity and dignity reliability and punctuality In summary, the role of the interpreter can be to: facilitate communication, not conduct the interview interpret only, that is, convey messages accurately without addition, omission or editing (ensure all communication is relayed accurately without being ‘filtered’) interpret as the service provider assists the client to complete a form or take details or a history
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when required read some information out to the client in the client’s language (sight interpreting) as long as it is not of a very complex nature or very long. It remains the responsibility of the service provider to provide information to the client. Interpreters do not: act on the service provider or client’s behalf fill out forms take information or provide information to the client.
1.1.2 Styles of Interpreting There are four main styles of interpreting. Knowing the difference will help to determine which style if best for your situation. Consecutive Interpreting – is the most common style of interpreting where the speaker and the interpreter speak one after each other. The interpreter listens to a few sentences or messages and then says this in the other language, while the speaker/interviewer pauses. The speaker will continue and the process repeats itself. Simultaneous Interpreting – is commonly used in conference proceedings where the interpreter listens to the first words that the speaker says, then proceeds to interpret this immediately and continuously as they continue to talk, so that the speaker and the interpreter are speaking simultaneously. Chucotage Interpreting (whispered interpreting) – is commonly used in court proceedings where the interpreter keeps the client informed of discussion taking place within the body of the court, such as legal deliberations between the parties, evidence of other witnesses etc. Sight translations – occurs when an interpreter is required to provide oral and instantaneous interpretation of a written text, such as a court order or a form.
1.1.3 Critical Points when an Interpreter should be used Access to information in a client’s preferred language is essential at the following points: When critical information about the client’s circumstances need to be communicated and understood by them When the client is required to make significant, informed decisions about their health care Initial intake/contact when collecting client information and assessing need When undertaking assessments When explaining service and therapy options When client consent is required For client and carer feedback When determining appropriate referral For early intervention and prevention community education/information health promotion activities Participation in implementation and monitoring of individual plans
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1.1.4 Accredited on-site interpreters Assessing if an Interpreter is required An assessment of a client's level of understanding and ability to express themselves in English will determine whether an interpreter is needed The decision tree for using an interpreter (Appendix 1) can be a useful resource for assisting staff to determine the kinds of communication exchanges that require the use of interpreters Ask open questions beginning with 'what', 'why', 'which' and 'how' rather than closed questions which only need a 'yes' or 'no' answer. For example, 'Tell me about your family' or 'How did you get here today?' This is particularly important in the case of new arrivals to Australia such as refugees and humanitarian entrants who may not be aware of interpreting services and their right to request one. When to use an on-site interpreter An accredited interpreter may be used when: the client requests an interpreter the client has no or very limited English conversation the client shows hesitation or difficulty in understanding or communicating in English the client can hold one-to-one conversations, but cannot follow group discussions in English the client has basic competence in English but may not be able to engage in conversation adequately in English where there is the use of complicated, technical or highly emotive English language phrases the client temporarily loses their English fluency under stress the service provider cannot understand the client. Service providers have a right to request an interpreter as well as clients. Interpreters should not just be seen as providing a service to a client; they are also available to facilitate communication for the service provider and to enable them to do their job and fulfill their role and obligations as part of their position description. Staff members should be aware of the risk they may be exposing themselves, that can include not fulfilling their Duty of Care to their client to as a result of not using interpreters topics or concepts at hand are complex and require advanced level of English to be able to understand them, or the dynamics of the situation impede communication bilingual staff or CLAS officers (ADHC only) are not available (as a first point of contact or for simple enquiries)
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When a client refuses an interpreter Clients may initially refuse to have an interpreter even when one may be needed, often for confidentiality reasons. Staff should: assure the client and carer of the interpreter's confidentiality, impartiality and accuracy and explain the importance of the interpreter for effective communication ask questions to understand the reasons for refusing an interpreter explain the communication and service risks involved if an interpreter is not used if appropriate, continue communication with client without interpreter and reassess the situation. At times, once trust is established with the service provider, the client can change his/her mind, and if refusal continues, only as a last resort use family/friends but not children under 18 years of age. If the client continues to refuse to use an interpreter see Appendix 2.
When an accredited on-site interpreter is not available An accredited on-site interpreter may not be available for the following reasons: No accredited interpreter available at your preferred date and time No accredited interpreter available in a particular language. For example, there are no accredited interpreters for some of the new and emerging language groups. In these instances it is important to follow the critical path detailed in Appendix 3. For example, if an on-site interpreter was required and is not available, would a telephone interpreter be appropriate? Appendix 6 provides information on the rights and responsibilities of parties to a communicative discourse (spoken, written or in sign language) to assist with decision making when an accredited interpreter is unavailable. Interpreter not used In all cases where an accredited interpreter or translating service has not been used, details of the decision and the circumstances justifying that decision should be specifically documented on the client’s file in the form of a file note signed by your supervisor or manager.
1.1.5 Procedure for booking an interpreter To make a booking: obtain approval from your supervisor/manager to book an interpreter complete the relevant interpreter request form (depends on the preferred provider). ADHC is not exempt from fees. An account can be established with the provider by faxing an authorised request on agency letterhead at the time of the first request stipulate on the request form that an interpreter with NAATI accreditation is required. Not all emerging languages in Australia have been accredited by NAATI. However, some external providers have interpreters in these languages who are undergoing training and/or have NAATI Recognition. stipulate the following details on the request form:
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- preferred language and dialect (many countries have more than one official language and many immigrants in Australia speak more than one non-English language). Be as specific as possible, for example ‘Bengali’, ‘Hindi’, ‘Punjabi’, ‘Tamil’ or ‘Urdu’ NOT ‘Indian’. - preferred gender and ethnicity of interpreter - your name, position and contact numbers - exact interview location and preferred time (be prepared to negotiate the time and date). Take into account the value of a short briefing to the interpreter before the session with the client begins. - any specific requirements - some detail on the topic to be covered so the interpreter can come to the session prepared. For example ‘The interpreting session will involve an aged care assessment’. ensure the duration is realistic including time for briefing and debriefing. If you need an hour, don’t accept a half hour appointment and expect the interpreter to stay longer than the booking. Negotiate a day or time when you can book the full hour you need forward the form to the appropriate provider and confirm the booking by obtaining a job/assignment number from the service provider give as much notice as possible (minimum of 5 days) to ensure an appropriate interpreter will be available. Be prepared to negotiate a time and date for onsite bookings as interpreters are in high demand if possible, send out some information about your agency (or specific information about the relevant service if this is known) to the interpreter. Provide the interpreter with a copy of translated disability terms (refer to Section 5.1.9) record the need for an interpreter and what language the client or carer speaks on the client’s file. This information should also be recorded on the Interpreter Bookings Monitoring Sheet and in CIS (ADHC only, see Appendix 8). This is important to ensure accurate data on language services requirements is available for reporting and planning. Procedure for booking an interpreter for a Deaf or Hearing Impaired person When booking an interpreter for a Deaf or Hearing Impaired person, ascertain the preferred mode of communication, which includes: Australian Sign Language (Auslan) Signed English (used by children and adolescents with a hearing impairment) fingerspelling only (usually only used by elderly Deaf or Hearing Impaired people). For people who are Deafblind: hand over hand (Auslan) visual frame (Auslan) tactile fingerspelling For Deaf or Hearing Impaired people who lack fluency in Auslan, Signed English or fingerspelling, (due to educational or linguistic disadvantage, intellectual, psychiatric or physical disability, or having recently migrated to Australia), a Deaf relay interpreter may also be required to work in a team with an Auslan interpreter.
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For more information: Deaf Society NSW – www.deafsocietynsw.org.au Able Australia – www.ableaustralia.org.au Australian Sign Language Interpreter’s Association – www.asliansw.org.au/book.php National Auslan Interpreter Booking and Payment Services (NABS) www.nabs.org.au NABS provides interpreters to any person who uses sign language to communicate and would like an interpreter for private medical appointments
1.1.6 Working with an on-site interpreter Before the interview Arrange to meet the interpreter outside the client’s home or meeting venue immediately prior to the interview if possible. Inform the interpreter about your agency, the service (if known) and the client. Establish the purpose and goals of the interview. Establish the mode of interpreting (i.e. consecutive or simultaneous): - Consecutive interpreting: the interpreter interprets what is said immediately after each sentence or section of speech. - Simultaneous interpreting: the interpreter interprets what the speaker says at the same time and at the same rate as the speaker. Arrange the seating so that you are sitting opposite the client with the interpreter sitting beside the client (community language) or with the interpreter sitting beside you (Auslan). During the interview Introduce yourself and the interpreter to the client. Explain roles and set ground rules. Emphasise that the session will be confidential. Look at the client when speaking, not the interpreter. Maintain eye contact unless this is deemed culturally inappropriate. Speak in the first person. For example, "How are you feeling?" not "Please ask the client how she is feeling." Speak slowly and clearly, using short sentences and pausing often. Use plain language, avoid using jargon. Summarise your discussion regularly throughout the interview and ask the client to summarise what has been said to ensure you and the client share the same understanding. Avoid talking to the interpreter in front of the client unless absolutely necessary. If you must discuss something, always tell the client what you are discussing and why. If the ground rules are broken during the interview, stop straight away and restate them. Difficulties which may occur If any of the following happens, stop the interview and resolve the issue. the interpreter knows the client
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there is a confusion of roles the interpreter takes over the client and the interpreter ignore the interviewer the client does not trust the interpreter the client rejects the interpreter the interpreter feels distressed through over-identification with the client and/or circumstance. After the interview If possible, assess the effectiveness of the interpreting i.e. ask the interpreter how it went and if in their opinion the client understood. If you must discuss this in the client's presence explain what you are discussing. Give the interpreter the opportunity to express any feelings or issues that may have come up for them in the interview. This should not be conducted in the presence of the client. If subsequent interpreting sessions are needed, contact the service provider and try to book the same interpreter. Document in the client information system: the date and time an interpreter was used, in what language and whether it was on-site or telephone.
1.1.7 Accredited telephone interpreting Some languages are accessible without notice but some may require pre-booking. Also let the operator know if it is urgent as interpreters can be accessed from other states. When to use telephone interpreting simple enquiries filling in forms gathering information from a client to book an interpreter arranging an appointment teleconferences (e.g. in rural areas where the use of on-site interpreters is difficult) Telephone interpreting is not recommended for lengthy interviews, particularly if important or sensitive issues are being discussed. However, it is an option to be considered if an on- site interpreter is not available. Booking a telephone interpreter Obtain approval from your supervisor/manager to book an interpreter. Call a telephone interpreting service (see pages 17 and 18 for list of providers and contact details) and provide the following information: - the language required - the agency number (this may be a specific number for your branch / business unit) - the time, date and estimated duration of the interpreting assignment - your first and last name - the client's first and last name
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- the client's gender
1.1.8 Procedure for making a complaint about an interpreter To ensure that clients are assisted by high calibre interpreters, clients are encouraged to provide feedback to the agency requesting the service on the standard of interpreting and translating services provided. Where a complaint is made concerning the calibre or use of interpreter services, the staff member should support the client and handle the complaint in accordance with the requesting agency’s complaint handling procedures. In the case of ADHC standard feedback and complaint handing principles and guidelines apply. In the first instance, if there are concerns around the accuracy of the interpreting session or a breach or potential breach of the AUSIT code of ethics, the staff member should raise these concerns with the interpreter, so that it can be addressed immediately. If this cannot be resolved at the local level, staff should request for the name of the interpreter and contact the interpreting agency to lodge a complaint.
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1.1.9 Interpreting Services
Providers Contact Details Department of Immigration and Citizenship (DIAC) – Translation On-site Interpreter:
and Interpreting Service (TIS) Phone: 1300 655 082 (Provide on-site and telephone interpreting) Fax: 1300 654 151 TIS provides interpreters for appointments in the following contexts: Telephone Interpreter: Government Phone: 131 450 Business Fax: 1300 654 151 Hospital / Medical Legal Counseling Educational Community Relations Commission for a Multicultural NSW Phone: 1300 651 500
(CRC) – Language Services Division Fax: (02) 8255 6711 (Provide Auslan and on-site interpreters) TTY: (02) 8255 6758 The CRC provides interpreters for appointments in the following contexts: Police and Court matters (including emergencies) Government departments / Business organisations Licence testing Workshops General Health Care Interpreting Service (HCIS) (Provide Auslan, on-site and telephone interpreters)
HCIS in each area health service provides interpreters for health or medical appointments in the public health care system. For example:
Public hospital (including emergencies) Public dental hospital Psychiatric hospital
Government Health funded service Community Health Centre
Sydney West Phone: (02) 9840 3456 Fax: (02) 9840 3789
South Eastern Sydney / Illawarra Phone: (02) 4274 4211
Fax: (02) 4276 2487
Sydney South West Phone: (02) 9828 6088
Fax: (02) 9828 6090
Northern Sydney Phone: (02) 9926 7690 Fax: (02) 9926 7979
Hunter New England Area (covers northern and western NSW Phone: (02) 4924 6285 rural areas) Fax: (02) 4924 6287
Illawarra Area (covers southern NSW rural areas) Phone: (02) 4274 4211 Fax: (02) 4924 6287
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Providers for a Deaf / Hearing Impaired Person Contact Details (in addition to above)
Deaf Society of NSW Voice: (02) 8833 3611 (Sign Language Communications NSW) Fax: (02) 8212 5836 TTY: (02) 8833 3653 (Provide Auslan Interpreters. The Interpreting Service also Email: provides interpreters for people who are Deafblind and for Deaf interpreting@deafsociety people who need a Deaf relay interpreter.) .com The Deaf Society of NSW provides interpreters for a range of contexts. For example: Private legal Bank/Financial institution Funeral Meeting Education Workplace Public Events National Auslan Interpreter Booking and Payment Service Phone: 1800 246 945 (NABS) Fax: 1800 246 914 (Provide Auslan Interpreters) TTY: 1800 246 948 SMS: 0427 671 261 NABS is funded by the Department of Family and Community Email: Services and is an Australia-wide service. The service provides [email protected] interpreters for private medical appointments. For example:
Local Doctor (GP) and Specialists
Private Dentist or Optometrist Private hospital Other health, e.g. counselling, physiotherapy, mental health, audiologist, Occupational therapist, podiatrist.
This service is free to all users for specified private and health care appointments
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1.2 Guidelines for Using Translated Information The Policy recognises the need to produce multilingual information in order to operate more effectively in a culturally and linguistically diverse society. Translations are another channel for communicating core information about services and programs and disability and ageing issues to clients and their carers and families from CALD backgrounds. The Guidelines aim to inform the practice of translating in order to build the ADHC’s and funded agencies’ capacity to produce and use information in multilingual formats. As a guiding principle, translated information and resources should be shared across agencies to avoid duplication of translations by different regions and business units. To facilitate this process within ADHC, staff should inform the Cultural Diversity Team in Community Access so materials can be uploaded to the ADHC website and intranet. Points to consider when deciding to translate information Ascertain whether or not translation is required Translations can be an effective medium for disseminating information to people from CALD background when appropriate. Before proceeding with a translation consideration of the following is important: An understanding of specific needs of different community groups to ensure information is relevant and meaningful Does the information content match the needs of specific community groups? Is the translation generated by a direct response to identified community needs or a translation of existing or new English materials? How do we know that translation is the best way to promote programs/information to the targeted CALD communities? Can we best promote the program/information alongside other complementary mediums such as audio/visual material, community education/information programs through ethnic community networks/leaders, ethno-specific orgs, peak NGOs, bilingual workers, ethnic community radio programs etc? What other sources of information are already available to the client? Has the information been translated by another region, NGO? Are there other methods of communicating information if literacy levels are low (such as audio-visual formats)? Deciding what and how to translate When deciding what information to translate and how best to undertake the process the following should be considered: Always consider the 4 ‘Ws’ of translation – what will be translated, why is translation the best option for communication, for whom is the information to be translated and who will provide the translation service? What process will be used for translations for example - do we need to undertake some scoping of need to ascertain relevance of information to be translated for the intended audience?
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- who will write the material? who will proof-read the material to ensure cultural and linguistic appropriateness and meaningfulness? Which service provider will you use and what will be the cost? Is the information written in plain English to facilitate the translation process? Is the information in the English version relevant and meaningful to the needs of people from CALD that are eligible to access these programs? Information to ascertain prior to a translation Before proceeding with a translation, staff must consider: What is the demographic profile of the region and/or intended audience? For example, if the information relates to ageing issues/services what is the CALD ageing profile? When choosing your target groups remember to always consider the needs and demographic profile of new and emerging communities. Priority should not necessarily be calculated on the basis of numbers. Proportional need must be assessed on the basis of access issues, specific community needs, level of community supports and English language proficiency, years of residency in Australia. The languages your current and potential clients read and write The level of literacy among clients not proficient in English Level of literacy of intended audience in their first language Any alternative preferred means for communicating Whether the information may already have been translated How this information will be distributed/promoted in order to reach the intended audience Whether standard print is the best format (to ensure information is accessible, it may be necessary to use means of communication other than standard print such as extra large print or audio/visual formats) Types of information to translate The following may be made available in languages other than English based on identified priorities and state-wide needs: publications, pamphlets, brochures, information packages letters, forms and other documents directed to clients and their families and carers from culturally and linguistically diverse backgrounds audio/visual information such as DVDs, community language radio programs Approval required Within ADHC Delegated Officers can approve the translation of material from their operating budget.
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Translation Services
Providers Contact Details
Department of Immigration and Citizenship Phone: 1300 655 820 (DIAC)
Translation and Interpreting Service (TIS) http://www.immi.gov.au/media/f Translation Services (for new migrants ONLY) act-sheets/91tis.htm#f
Community Relations Commission for a Phone: 1300 651 500 multicultural NSW (CRC) Fax: 9716 2287
Language Services Division http://www.crc.nsw.gov.au/servi ces/emaillink/translation_service s
NSW Multicultural Health Communication Service Phone: 9816 0347 Fax: 9816 0302
Email: [email protected]. au
http://www.mhcs.health.nsw.gov .au/services/translation/translati on.asp
There are also private translation services.
Writing information to be translated When writing materials which will be translated: use plain English use simple, short sentences be direct and to the point use everyday words not jargon or technical words consider whether an English speaking person could understand what you wrote. Testing translated information It is important to check the accuracy, relevance and appropriateness of translated material. For publications and other material (e.g. forms and standard letters) intended for repeated distribution, staff should: ensure the use of accredited or recognised translators organise for the translated material to be checked by a second accredited translator consider the option of running a small test group with members of the community. Bilingual staff may also be used in this instance. However, they do need clear guidance on what they are being asked to do. For example, a bilingual worker may be asked to check, edit or proofread a document and this does not mean re-writing the translated text or changing its style.
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Engaging a translation service Obtain approval from your supervisor/manager before proceeding with the translation of material. Ascertain appropriate translation service, cost and quantity of translations. Ensure funds are available for translation and for printing costs. Fax or email document to be translated to the relevant translation service provider. Allow approximately two days for a quotation of cost. If the cost is acceptable allow a minimum of seven days for material to be translated (depending on the language and the length of the document it could take longer). 1.3 Guidelines for Accessing and Using Bilingual Staff Bilingual staff may be asked to interpret only as a first point of contact and/or for simple enquiries. These staff should not be used to interpret complex and sensitive interactions because there is a potential for misinterpretation and conflict of roles. Bilingual staff are employed in a range of different roles and as interpreters. Therefore, they will only have a limited amount of time to assist with simple enquiries (see Appendix 1). Within ADHC Community Language Allowance Scheme (CLAS) Officers are recipients of the community language allowance and have a basic level of competency in a language other than English. CLAS Officers work in locations where their language can be used to assist clients. To access a CLAS Officer contact your Manager in the first instance, Regional Executive Manager or Regional Manager. If a CLAS Officer is not available, an accredited interpreter should be used.
1.3.1 Community Language Allowance Scheme (CLAS) – ADHC Only The Community Language Allowance Scheme (CLAS) provides an allowance, additional to salary, paid by New South Wales Government agencies to approved employees who use a language other than English to communicate with clients, as part of their normal duties (NSW Government C1998-14 Community Language Allowance Scheme). Further information about the CLAS can be found on the intranet at http://dadhc- intranet.nsw.gov.au/documents/about_dadhc/cultural_diversity/CLAS_information_sheet.p df The CLAS is one strategy to assist in achieving effective communication in a culturally diverse society. Like other bilingual staff, CLAS Officers are available to assist only as an initial point of contact and/or for simple inquiries. This system has been established to address the need for government agencies to assist at initial point of contact and provide on-the-spot assistance for simple, uncomplicated matters. Some examples include answering counter inquiries, providing directions to another office, or making appointments for a further visit. For matters that will take a longer time, or require an in-depth or formal interview, staff should use interpreters. This is necessary for two reasons: CLAS recipients may not have professional qualifications in interpreting which are highly desirable for more extended interviews. In addition, as CLAS duties are additional to a normal, full or part-time working load, it is expected that work through the CLAS scheme will not impact significantly on the employee’s other working commitments.
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Qualifying to receive the allowance under the CLAS Calls for CLAS nominations are made once a year. Employees must be nominated by their supervisor/manager to receive an allowance under the CLAS. Staff must qualify for an allowance in one of three ways: i. by passing an examination administered by the Community Relations Commission for a multicultural NSW (CRC), ii. by having NAATI accreditation at interpreter level, or iii. by having a language recognition award from NAATI. The allowance is not payable to employees who are employed as interpreters and translators or who work in positions where particular language skills are part of the essential requirements of the position. The allowance is payable to staff who have passed the examination or have NAATI qualifications and are: public contact staff, counter staff or other clerical staff who, by possessing language skills, are required to deal with public inquiries; identified as possessing another language skill for the purpose of the work of the organisation; available to use the language skill as required by the organisation; and recognised by management as occasional or regular users of their language skills as an adjunct to their normal duties. Examination arrangements for CLAS An examination of language competency is conducted, usually annually, by the Community Relations Commission . Advertisements are placed in the Public Sector Notices. ADHC also circulates information to the Regions requesting their assistance in nominating staff for the CLAS examination. It is the responsibility of each Region/Directorate to meet the cost of the examination for their nominated staff. A number of public sector staff may hold certificates issued by the CRC or the former Public Service Board of NSW, which have a time limit on their currency (usually ten years). The CRC can renew these certificates following confirmation of continuous use of the language and upon payment of a renewal fee. No examination is required to be undertaken in these circumstances unless requested by the staff member concerned. Rate of the allowance The rate of allowance is contained in the CLAS determination issued by the Department of Premier and Cabinet. There are two levels of allowance - a base level rate and a higher level rate. Rates effective from 1 July 2010 are set out in C2010-28 Review of Meal, Travelling and Other Allowances The base level rate is paid to staff who are required to meet occasional demands for language assistance. Occasional demand mean there is no regular pattern of demand that necessitates the use of the staff member’s language skills. The higher level rate is one and a half times the base allowance. It is paid to staff who meet any of the following criteria:
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- regularly meet high levels of client demand involving a regular pattern of usage of the staff members’ language skills. - have achieved qualifications of NAATI interpreter level and above. This recognises that staff with higher levels of language skills will communicate with an enhanced degree of efficiency and effectiveness. Responsibilities of CLAS recipients CLAS recipients are responsible for: providing timely and accurate language assistance keeping informed about agency services and referral points determining if a matter is formal or sufficiently complex to warrant using interpreters and notifying the appropriate person to ensure that this assistance is provided keeping records of CLAS usage as required by the agency notifying the manager/supervisor if the CLAS workload is excessive, that is, if the demand for CLAS assistance is impacting negatively on the employee’s normal workload attending any training and information sessions on CLAS at the instruction of the agency. Manager and supervisor responsibilities Implementing, monitoring and reviewing CLAS Supervisors/Managers are responsible for implementing, monitoring and reviewing the CLAS in their Region. The following steps are a good practice guide for CLAS: survey employees to determine the range of languages available and their locations survey employees at client contact points to determine the need for language assistance by clients analyse the local demographic profile to match potential language demand analyse the language needs to determine those needs that could be met by a CLAS recipient and those requiring an interpreter integrate CLAS functions into a client service plan call for nominations from staff for CLAS testing from locations where CLAS could be used effectively or from staff who wish to have NAATI qualifications recognised determine which employees should be accepted for CLAS testing or should have their NAATI qualifications recognised arrange for testing for those employees who do not have NAATI qualifications and request documentation of NAATI qualifications from those claiming NAATI accreditation at interpreter level. monitor the level of demand for CLAS, languages used, and types of matters dealt with by CLAS recipients. CLAS recipients are required to maintain a log of their CLAS duties to facilitate the monitoring of the scheme in the agency (see Appendix 5). review the scheme and make recommendations for the program in the following year – based on the outcomes of monitoring. Recommendations may include changes in the languages and/or the locations covered by CLAS, changes in interpreter use and changes in the level of payment. Recommendations may also include the cessation of
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CLAS payments to recipients where the circumstances are no longer justified. Agencies should ensure there has been prior consultation with the staff member concerned so that sufficient time is given to enable the staff member to adjust their personal circumstances prior to the payment ceasing. Monitor the scheme yearly, or no less frequently than two yearly. The CLAS is a tool that aims to increase the quality of client service. In order to ensure that CLAS operates effectively, managers/supervisors should ensure that the following are implemented: the workload of CLAS recipients includes time for CLAS work that sufficient employees are nominated for the CLAS to enable client demand for language assistance to be met without excessive impact on the normal work of particular CLAS employees that interpreters are used for matters that fall outside the provision of simple language assistance that workloads are spread equitably within work groups and that certain employees are not given responsibility for looking after the clients of particular language groups that CLAS recipients attend training and or monitoring sessions organised by ADHC.
1.4 Translated Glossaries Disability Terms in Community Languages The Multicultural Disability Advocacy Agency (MDAA) was commissioned by ADHC to produce translations of disability terms in 13 community languages. The purpose of these translated terms is to prevent inconsistency and misunderstanding and to break down two main barriers to effective interpretation: some translations are wrong, unclear or refer to disability in negative ways some of the words and ideas belong to the Anglo-Australian culture and cannot be translated easily or simply into other languages or cultures where there are no similar ideas. Disability Terms in Community Languages are available on the ADHC website and intranet. Staff should download a copy of disability terms in the relevant language and provide a copy to the interpreter before the interview. This resource is very useful for Interpreters who may not be trained in disability issues and terminology. Other Resources The Centre for Cultural Diversity in Ageing has developed a resource for interpreters and translators to ensure the consistency of translations of aged care terminology. The Glossary of Aged Care Terminology has been translated into 33 community languages and is available from their website: www.culturaldiversity.com.au. The Centre for Culture, Ethnicity and Health has available the BBV/STI Multilingual Glossary which is a resource for interpreters who work in health settings. It offers an extensive list of English terms related to sexual health and blood-borne viruses (such as hepatitis) translated into 10 languages, as well as definitions in simple English.
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2 Appendices
Appendix 1 – Decision tree 1: using an interpreter Appendix 2 – Decision tree 2: when a client refuses to use an interpreter Appendix 3 – Decision tree 3: when an interpreter is not available Appendix 4 – Explanation of Terms Appendix 5 – Interpreter and translator accreditation levels Appendix 6 – Rights and responsibilities of parties to a communicative discourse Appendix 7 – CLAS recipient worksheet Appendix 8 – ADHC interpreter bookings monitoring sheet Appendix 9 – Aboriginal languages Appendix 10 – Community languages by country
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Appendix 1 – Decision tree 1: using an interpreter1
A client has hesitation or difficulty in understanding and communicating in English
Is it a general matter requiring simple communication?
YES NO
Contact a CLAS officer or a bilingual worker for telephone or face-to-face The matter is lengthy, communication complex, technical or legal
If a CLAS officer or bilingual Contact an accredited Interpreter for worker is unavailable telephone or face-to-face communication Call an accredited interpreter
Use an on-site accredited interpreter
If an on-site accredited interpreter is not available, use an accredited telephone interpreter
If the person is deaf, use an AUSLAN interpreter
1 Language Services Policy, Department of Human Services, Victoria, March 2005 - www.dhs.vic.gov.au/multicultural
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Appendix 2 – Decision tree 2: when a client refuses to use an interpreter2
Can the client speak some English?
Yes NO
Try to explore with the client the Try to explore with the client the reason for their refusal to use an reason for their refusal to use an interpreter, using a telephone interpreter. Explain to the client the interpreter or a bilingual staff disadvantages of not using a member. If these options are professional interpreter. unacceptable to the client, use a family member or friend of the client to interpret. Do NOT use a child or relative under 18 years of age to interpret. Explain to the client the advantages of using an accredited professional and the disadvantages of not using one.
Can the client’s concerns be addressed?
Yes NO
Use an interpreter If appropriate, continue interview without an interpreter. If necessary, use a family member or friend of the client to interpret. Do NOT use a child or relative under 18 years of age to interpret. Record the reason for doing so in the client’s file.
2 Language Services Policy, Department of Human Services, Victoria, March 2005 - www.dhs.vic.gov.au/multicultural
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Appendix 3 – Decision tree 3: when an interpreter is not available3
Can the appointment be postponed?
Yes Postpone the appointment until a time that an interpreter is available
NO
If an onsite interpreter was required and is not available, would a telephone interpreter be appropriate? Remember to make sure you tell them it is urgent when you call; an interpreter can usually be located in an emergency.
Yes Use an interpreter NO
Is an interpreter available who is accredited at a lower level?
Yes Use an interpreter NO
Is a bilingual worker or CLAS officer available?
Yes Use the staff member NO
Use a family member or friend of the client to interpret. Do NOT use a child or relative under 18 years of age to interpret. Record the reason for doing so in the client’s file.
3 Language Services Policy, Department of Human Services, Victoria, March 2005 - www.dhs.vic.gov.au/multicultural
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Appendix 4: – Explanation of Terms
Accredited interpreters Interpreters and translators who have been tested and accredited and translators by the National Accreditation Authority for Translators and Interpreters (NAATI). See appendix 4 for details on the different levels of accreditation.
ASLIA The Australian Sign Language Interpreters Association is the professional body representing Australian Sign Language (Auslan) interpreters.
AUSIT The Australian Institute of Interpreters and Translators Incorporated is a professional association for translators and interpreters.
Auslan Auslan is the sign language of the Australian Deaf Community and is a recognised language. There are accredited interpreters for Auslan users. Auslan is different from signed English which some younger people with hearing impairments may use. Usually, an accredited Auslan interpreter will be able to communicate with a person who uses signed English.
Bilingual Workers A bilingual worker refers to any person who has been employed on (refers to identified the basis of their language and cultural skills and/or uses or could bilingual positions only) use their language skills as part of their work. Bilingual workers are NOT professional interpreters and should not be used to interpret complex and sensitive interactions because there is a potential for misinterpretation and conflict of roles.
Community Language CLAS is an allowance paid to approved NSW public sector Allowance Scheme employees who have a basic level of competency in a language (CLAS) other than English and who work in locations where their language can be used to assist clients.
CLAS Officers CLAS Officers are NSW public sector employees who are paid the community language allowance and are available to assist with the initial point of contact and/or for simple inquiries. CLAS Officers are NOT professional interpreters and should not be used to interpret complex and sensitive interactions because there is a potential for misinterpretation and conflict of roles.
Department of The purpose of DIAC is to manage the entry and settlement of Immigration and people to Australia. Citizenship (DIAC)
Health Care Interpreter The HCIS provides services in over 120 languages, including Service (HCIS) AUSLAN (Australian Sign Language) for Deaf clients. Interpreters have been specifically trained to understand medical terms and know how the NSW public health system works.
Interpreters Interpreters work with the spoken word. Interpreters help people of different nations, cultures and abilities to communicate by overcoming the language barriers which separate them. They do this by transferring information from one language to another.
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Interpreters with NAATI NAATI Recognition is an award in a totally separate category from Recognition accreditation. It is granted only in languages for which NAATI does not test and it has no specification of level of proficiency. This is generally the case for low demand or emerging languages.
Language services Language services refers to actions taken by agencies to help people who have difficulty in communicating in English, including the engagement of interpreters and translators and the use of planned bilingual information strategies.
Multicultural Disability MDAA is the peak organisation for people from non-English Advocacy Association speaking backgrounds (NESB) with disability, their families and of NSW (MDAA) carers in NSW. It aims to promote, protect and secure the rights and interests of people from NESB with disability, their families and carers in NSW.
National Accreditation NAATI is the national standards and accreditation body for Authority for Translators translators and interpreters in Australia. It is the only agency that and Interpreters Ltd issues accreditations for practitioners who wish to work in this (NAATI) profession in Australia.
National Auslan NABS is funded by the Department of Families Community Interpreter Booking and Services and Indigenous Affairs and provides services Australia- Payment Service wide. NABS provides interpreters to any person who uses sign (NABS) language to communicate and would like an interpreter for private medical appointments. It is free of charge to Sign Language users and medical and health care practitioners. All interpreting services to Aboriginal and Islander Sign Language users are provided free of charge for both public and private health appointments. NABS also provides interpreters for deaf/blind people.
Translating and The Department of Immigration and Citizenship provides the TIS Interpreting Service National interpreting service for people who do not speak English (TIS) National and for the English speakers who need to communicate with them. TIS National has access to over 1,300 contracted interpreters across Australia, speaking more than 120 languages and dialects. TIS National is available 24 hours a day, seven days a week for any person or organisation in Australia requiring interpreting services.
Translators Translators work with the written word. They change written information from one language into another.
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Appendix 5: – Interpreter and Translator Accreditation Levels
Interpreters Paraprofessional Interpreter (PPI) (formerly known as level 2) This represents a level of competence in interpreting for the purpose of general conversations. Paraprofessional Interpreters generally undertake the interpretation of non- specialist dialogues. Practitioners at this level are encouraged to proceed to the professional levels of accreditation. Professional Interpreter (PI) (formerly known as level 3) This is the first professional level and represents the minimum level of competence for professional interpreting. Interpreters convey the full meaning of the information from the source language into the target language in the appropriate style and register. Interpreters at this level are capable of interpreting across a wide range of subjects involving dialogues at specialist consultations. They are also capable of interpreting presentations by the consecutive mode. Their specialisations may include banking, law, health, and social and community services. Conference Interpreter (CI) (formerly known as level 4) This is the advanced professional level and represents the competence to handle complex, technical and sophisticated interpreting. Conference Interpreters practise both consecutive and simultaneous interpreting in diverse situations, including at conferences, high-level negotiations, and court proceedings. Conference Interpreters operate at levels compatible with recognised international standards, and may choose to specialise in certain areas. Conference Interpreter (Senior) (CIS) (formerly known as level 5) This is the highest level of NAATI accreditation and reflects both competence and experience. Conference Interpreters (Senior) are Conference Interpreters with a level of excellence in their field, recognised through demonstrated extensive experience and leadership. Recognised Interpreter NAATI Recognition is an award in a totally separate category from accreditation. Recognition is only granted in ‘new and emerging’ languages or in languages of low community demand for which NAATI has not developed accreditation testing. Translators Paraprofessional Translator (PPT) (formerly known as level 2) This represents a level of competence in translation for the purpose of producing a translated version of non-specialised information. Practitioners at this level are encouraged to proceed to the professional levels of accreditation. Professional Translator (PT) (formerly known as level 3) This is the first professional level and represents the minimum level of competence for professional translating. Translators convey the full meaning of the information from the source language into the target language in the appropriate style and register. Translators at this level work across a wide range of subjects involving documents with specialised content. Translators may choose to specialise. They are qualified to translate into one language only or into both languages, depending upon their accreditation. Advanced Translator (AT) (formerly known as level 4) This is the advanced professional level and represents the competence to handle complex, technical and sophisticated translation. Advanced Translators handle complex, technical and sophisticated material, compatible with recognised international standards.
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They may choose to specialise in certain areas. Advanced translators are accredited to translate either into one language only or into both languages, depending upon their accreditation. Advanced Translator (Senior) (ATS) (formerly known as level 5) This is the highest level of NAATI accreditation and reflects both competence and experience. Advanced Translators (Senior) are Advanced Translators with a level of excellence in their field, recognised through demonstrated extensive experience and leadership.
Source: NAATI website at http://www.naati.com.au/index.asp. Accessed June 2009.
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Appendix 6 – Rights and responsibilities of parties to a communicative discourse Stakeholder Rights Responsibilities Non-English Has equitable access to government services 1. Respect the right of the agency to engage a speaker or Deaf Respect including not being coerced into competent interpreter / Hearing communicating in broken English 2. Respect the role of an interpreter Impaired person Request an interpreter or translated information 3. Not ask personal details of the interpreter in preferred language and to request specific 4. Be punctual and cooperative consideration of gender & religious/ cultural/ kinship affiliations Access to a competent Interpreter Staff - Request the services of a competent interpreter 5. Provide services that are non-discriminatory English speaker or translator and do not result in disadvantage to any Professionalism from interpreter or translator client due to language/ cultural barriers including compliance with the Australian 6. Request the services of a competent Institute of Interpreters and Translators Inc interpreter or translator and provide (AUSIT) Code of Ethics adequate job specifications Has access to a quality service from an 7. Treat the interpreter or translator with interpreting service provider respect 8. Ensure that the client is aware of the interpreter’s role 9. Ensure the interpreter is able to work in a safe, healthy environment 10. Provide the interpreter with adequate pre interview briefing and post interview debriefing 11. Deal with disputes/grievances promptly and appropriately 12. Maintain professionalism
Accompanying Attend interview by agreement from all parties 13. Not to interfere with interpreting persons 14. Provide support and speak only to the - family interviewee - friends 15. Not to ask questions of the interpreter after - relatives the interview
Interpreter/ Respect as a professional 16. Comply with the principles of impartiality and Translator Adequate briefing prior to an interview confidentiality Adequate instructions for translations 17. Provide a quality service, measurable in Safe and healthy working conditions terms of both accuracy and faithfulness 18. Wear appropriate interpreter identification or carry appropriate identification 19. Participate in briefings and debriefings 20. Maintain professionalism including being punctual and by dealing with complaints promptly and appropriately 21. Maintain skills by undertaking regular professional development
Service Adequate job specifications from agencies 22. Provide a high quality service to agencies provider Reliability and professionalism from Interpreters 23. Deal with disputes, grievances promptly and and Translators appropriately 24. Provide formal identification badges for interpreters which include their accreditation status 25. Treat Interpreters and Translators with respect 26. Provide support to Interpreters and Translators –safety, constructive feedback, proactive communication, transparent and fair job allocation, incentives for professional development and training 27. Provide professional development and training opportunities
Source: The Western Australia Language Service Policy 2008, Department of Communities, Office of Multicultural Interests
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Appendix 7 – CLAS Recipient Worksheet
Name: Language: Office: Region: Month: Leave Taken:
Date Assistance From Normal Did you Face-to-face Time Taken requested by office/division duties assist? (FF) Telephone name and yes/no yes/no (TEL) phone Translation (TRA)
Endorsed: Name: Position: Sign: Date:
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Appendix 8 – ADHC Interpreter Bookings Monitoring Sheet ______Branch / Business Unit
Date Language Amount Purpose Type*
* T = telephone O = on-site Tr = translation
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Appendix 9 – Aboriginal languages
Arakwal Djirringany Malyangapa Walbanga
Awabakal Eora Marawara Walgalu
Baanbay Galibal Minjungbal Wandandian
Bandjigali Gamilaraay Muruwari Wandjiwalgu
Baraba Garanggaba Nari Nari Wangaaybuwan Baraba
Barranbinya Gawambaray Nawalgu Wemba Wemba
Bidawal Geawegal Ngaku Wiljali
Bigambul Githabul Ngambaa Wilyagali
Birpai Gogai Nganyaywana Wiradjuri
Bolali Gujangal Ngarigo Wiriyaraay
Bundjalung Gumbaynggir Ngiyampaa Wonnarua
Danggali Gundungurra Ngunawal Worimi
Darkinung Gunybaray Nyangbal Yaygir
Daruk Gurungada Paakantyi Yitha Yitha
Darumbal Jaitmathang Thaua Yu Yu
Dhanggatti Ku-ring-gai Wadi Wadi Yugambal
Dharamba Kureinji Wadi Wadi Yuin
Dharawal Kurnu Wadigali Yuungay
Dhurga Madhi Madhi Wailwan Yuwaalaraay
Source: NSW Government Department of Aboriginal Affairs – Aboriginal Language Research and Resource Centre website
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Appendix 10 – Community languages by Country When seeking the assistance of an interpreter or translator, the appropriate language must be identified including dialects.
Afghanistan Dari Persian, Pashtu (both official), other Turkic and minor languages Albania Albanian (Tosk is the official dialect), Greek Algeria Arabic (official), French, Berber dialects Andorra Catalán (official), French, Castilian, Portuguese Angola Portuguese (official), Bantu and other African languages Antigua and Barbuda English (official), local dialects Argentina Spanish (official), English, Italian, German, French Armenia Armenian 98%, Yezidi, Russian Australia English 79%, native and other languages German (official nationwide); Slovene, Croatian, Hungarian (each official in Austria one region) Azerbaijan Azerbaijani Turkic 89%, Russian 3%, Armenian 2%, other 6% (1995 est.) Bahamas English (official), Creole (among Haitian immigrants) Bahrain Arabic, English, Farsi, Urdu Bangladesh Bangla (official), English Barbados English Belarus Belorussian (White Russian), Russian, other Belgium Dutch (Flemish) 60%, French 40%, German less than 1% (all official) Belize English (official), Spanish, Mayan, Garifuna (Carib), Creole Benin French (official), Fon, Yoruba, tribal languages Dzongkha (official), Tibetan dialects (among Bhotes), Nepalese dialects Bhutan (among Nepalese) Bolivia Spanish, Quechua, Aymara (all official) Bosnia and Herzegovina Bosnian, Croatian, Serbian English 2% (official), Setswana 78%, Kalanga 8%, Sekgalagadi 3%, other Botswana (2001) Brazil Portuguese (official), Spanish, English, French Brunei Malay (official), English, Chinese Bulgaria Bulgarian 85%, Turkish 10%, Roma 4% Burkina Faso French (official); native African (Sudanic) languages 90% Burundi Kirundi and French (official), Swahili Cambodia Khmer 95% (official), French, English Cameroon French, English (both official); 24 major African language groups Canada English 59.3%, French 23.2% (both official); other 17.5% Cape Verde Portuguese, Criuolo Central African Republic French (official), Sangho (lingua franca, national), tribal languages Chad French, Arabic (both official); Sara; more than 120 languages and dialects Chile Spanish Standard Chinese (Mandarin/Putonghua), Yue (Cantonese), Wu China (Shanghaiese), Minbei (Fuzhou), Minnan (Hokkien-Taiwanese), Xiang, Gan, Hakka dialects, minority languages Colombia Spanish Comoros Arabic and French (both official), Shikomoro (Swahili/Arabic blend) Congo, Democratic French (official), Lingala, Kingwana, Kikongo, Tshiluba Republic of the
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French (official), Lingala, Monokutuba, Kikongo, many local languages and Congo, Republic of dialects Costa Rica Spanish (official), English C te d'Ivoire French (official) and African languages (Dioula esp.) Croatian 96% (official), other 4% (including Italian, Hungarian, Czech, Slovak, Croatia German) Cuba Spanish Cyprus Greek, Turkish (both official); English Czech Republic Czech Danish, Faroese, Greenlandic (Inuit dialect), German; English is the Denmark predominant second language Djibouti French and Arabic (both official), Somali, Afar Dominica English (official) and French patois Dominican Republic Spanish Tetum, Portuguese (official); Bahasa Indonesia, English; other indigenous East Timor languages, including Tetum, Galole, Mambae, and Kemak Ecuador Spanish (official), Quechua, other Amerindian languages Egypt Arabic (official), English and French widely understood by educated classes El Salvador Spanish, Nahua (among some Amerindians) Equatorial Guinea Spanish, French (both official); pidgin English, Fang, Bubi, Ibo Eritrea Afar, Arabic, Tigre and Kunama, Tigrinya, other Cushitic languages Estonia Estonian 67% (official), Russian 30%, other (2000) Amharic, Tigrigna, Orominga, Guaragigna, Somali, Arabic, English, over 70 Ethiopia others Fiji English (official), Fijian, Hindustani Finnish 92%, Swedish 6% (both official); small Sami- (Lapp) and Russian- Finland speaking minorities French 100%, rapidly declining regional dialects (Provençal, Breton, Alsatian, France Corsican, Catalan, Basque, Flemish) Gabon French (official), Fang, Myene, Nzebi, Bapounou/Eschira, Bandjabi Gambia English (official), Mandinka, Wolof, Fula, other indigenous Georgian 71% (official), Russian 9%, Armenian 7%, Azerbaijani 6%, other 7% Georgia (Abkhaz is the official language in Abkhazia) Germany German English (official), African languages (including Akan, Moshi-Dagomba, Ewe, Ghana and Ga) Greece Greek 99% (official), English, French Grenada English (official), French patois Spanish 60%, Amerindian languages 40% (23 officially recognized Guatemala Amerindian languages, including Quiche, Cakchiquel, Kekchi, Mam, Garifuna, and Xinca) Guinea French (official), native tongues (Malinké, Susu, Fulani) Guinea-Bissau Portuguese (official), Criolo, African languages Guyana English (official), Amerindian dialects, Creole, Hindi, Urdu Haiti Creole and French (both official) Honduras Spanish (official), Amerindian dialects; English widely spoken in business Hungary Magyar (Hungarian) 94%, other 6% Iceland Icelandic, English, Nordic languages, German widely spoken Hindi 30%, English, Bengali, Gujarati, Kashmiri, Malayalam, Marathi, Oriya, India Punjabi, Tamil, Telugu, Urdu, Kannada, Assamese, Sanskrit, Sindhi (all
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official); Hindi/Urdu; 1,600+ dialects Bahasa Indonesia (official), English, Dutch, Javanese, and more than 580 Indonesia other languages and dialects Persian and Persian dialects 58%, Turkic and Turkic dialects 26%, Kurdish Iran 9%, Luri 2%, Balochi 1%, Arabic 1%, Turkish 1%, other 2% Iraq Arabic (official), Kurdish (official in Kurdish regions), Assyrian, Armenian Ireland English, Irish (Gaelic) (both official) Israel Hebrew (official), Arabic, English Italy Italian (official); German-, French-, and Slovene-speaking minorities Jamaica English, Jamaican Creole Japan Japanese Jordan Arabic (official), English Kazak (Qazaq, state language) 64%; Russian (official, used in everyday Kazakhstan business) 95% (2001 est.) Kenya English (official), Swahili (national), and numerous indigenous languages Kiribati English (official), I-Kiribati (Gilbertese) Korea, North Korean Korea, South Korean, English widely taught Kuwait Arabic (official), English Kyrgyzstan Kyrgyz, Russian (both official) Laos Lao (official), French, English, various ethnic languages Latvia Latvian 58% (official), Russian 38%, Lithuanian, other (2000) Lebanon Arabic (official), French, English, Armenian Lesotho English, Sesotho (both official); Zulu, Xhosa Liberia English 20% (official), some 20 ethnic-group languages Libya Arabic, Italian, and English widely understood in major cities Liechtenstein German (official), Alemannic dialect Lithuania Lithuanian 82% (official), Russian 8%, Polish 6% (2001) Luxembourg Luxermbourgish (national) French, German (both administrative) Macedonian 67%, Albanian 25% (both official); Turkish 4%, Roma 2%, Macedonia Serbian 1% (2002) Madagascar Malagasy and French (both official) Chichewa 57.2% (official), Chinyanja 12.8%, Chiyao 10.1%, Chitumbuka Malawi 9.5%, Chisena 2.7%, Chilomwe 2.4%, Chitonga 1.7%, other 3.6% (1998) Bahasa Melayu (Malay, official), English, Chinese dialects (Cantonese, Mandarin, Hokkien, Hakka, Hainan, Foochow), Tamil, Telugu, Malayalam, Malaysia Panjabi, Thai; several indigenous languages (including Iban, Kadazan) in East Malaysia Maldives Maldivian Dhivehi (official); English spoken by most government officials Mali French (official), Bambara 80%, numerous African languages Malta Maltese and English (both official) Marshallese 98% (two major dialects from the Malayo-Polynesian family), Marshall Islands English widely spoken as a second language (both official); Japanese Mauritania Hassaniya Arabic (official), Pulaar, Soninke, French, Wolof Mauritius English less than 1% (official), Creole 81%, Bojpoori 12%, French 3% (2000) Mexico Spanish, various Mayan, Nahuatl, and other regional indigenous languages English (official, common), Chukese, Pohnpeian, Yapase, Kosrean, Ulithian, Micronesia Woleaian, Nukuoro, Kapingamarangi Moldovan (official; virtually the same as Romanian), Russian, Gagauz (a Moldova Turkish dialect)
32
Monaco French (official), English, Italian, Monégasque Mongolia Mongolian, 90%; also Turkic and Russian (1999) Montenegro Serbian/Montenegrin (Ijekavian dialect—official) Arabic (official), Berber dialects, French often used for business, government, Morocco and diplomacy Portuguese 9% (official; second language of 27%), Emakhuwa 26%, Mozambique Xichangana 11%, Elomwe 8%, Cisena 7%, Echuwabo 6%, other Mozambican languages 32% (1997) Myanmar Burmese, minority languages English 7% (official), Afrikaans is common language of most of the population Namibia and of about 60% of the white population, German 32%; indigenous languages: Oshivambo, Herero, Nama Nauru Nauruan (official), English Nepali 48% (official), Maithali 12%, Bhojpuri 7%, Tharu 6%, Tamang 5%, Nepal others. English spoken by many in government and business (2001) Netherlands Dutch, Frisian (both official) New Zealand English, Maori (both official) Spanish 98% (official); English and indigenous languages on Atlantic coast Nicaragua (1995) Niger French (official), Hausa, Djerma Nigeria English (official), Hausa, Yoruba, Ibo, Fulani, and more than 200 others Bokmål Norwegian, Nynorsk Norwegian (both official); small Sami- and Norway Finnish-speaking minorities (Sami is official in six municipalities) Oman Arabic (official), English, Baluchi, Urdu, Indian dialects Urdu 8%, English (both official); Punjabi 48%, Sindhi 12%, Siraiki (a Punjabi Pakistan variant) 10%, Pashtu 8%, Balochi 3%, Hindko 2%, Brahui 1%, Burushaski, and others 8% Palauan 64.7%, English 9.4%, Sonsoralese, Tobi, Angaur (each official on Palau some islands), Filipino 13.5%, Chinese 5.7%, Carolinian 1.5%, Japanese 1.5%, other Asian 2.3%, other languages 1.5% (2000) Palestinian State Arabic, Hebrew, English (proposed) Panama Spanish (official), English 14%, many bilingual Tok Pisin (Melanesian Pidgin, the lingua franca), Hiri Motu (in Papua region), Papua New Guinea English 1%–2%; 715 indigenous languages Paraguay Spanish, Guaraní (both official) Peru Spanish, Quéchua (both official); Aymara; many minor Amazonian languages Filipino (based on Tagalog), English (both official); eight major dialects: Philippines Tagalog, Cebuano, Ilocano, Hiligaynon or Ilonggo, Bicol, Waray, Pampango, and Pangasinense Poland Polish 98% (2002) Portugal Portuguese (official), Mirandese (official, but locally used) Qatar Arabic (official); English a common second language Romania Romanian (official), Hungarian, German Russia Russian, others Kinyarwanda, French, and English (all official); Kiswahili in commercial Rwanda centers St. Kitts and Nevis English St. Lucia English (official), French patois St. Vincent and the English, French patois Grenadines Samoa Samoan, English
33
San Marino Italian São Tomé and Príncipe Portuguese (official) Saudi Arabia Arabic Senegal French (official); Wolof, Pulaar, Jola, Mandinka Serbian (official); Romanian, Hungarian, Slovak, and Croatian (all official in Serbia Vojvodina); Albanian (official in Kosovo) Seychelles Seselwa Creole 92%, English 5%, French (all official) (2002) English (official), Mende (southern vernacular), Temne (northern vernacular), Sierra Leone Krio (lingua franca) Mandarin 35%, English 23%, Malay 14.1%, Hokkien 11.4%, Cantonese 5.7%, Singapore Teochew 4.9%, Tamil 3.2%, other Chinese dialects 1.8%, other 0.9% (2000) Slovakia Slovak 84% (official), Hungarian 11%, Roma 2%, Ukrainian 1% (2001) Slovenia Slovenian 91%, Serbo-Croatian 5% (2002) English 1%–2% (official), Melanesian pidgin (lingua franca), 120 indigenous Solomon Islands languages Somalia Somali (official), Arabic, English, Italian IsiZulu 23.8%, IsiXhosa 17.6%, Afrikaans 13.3%, Sepedi 9.4%, English 8.2%, South Africa Setswana 8.2%, Sesotho 7.9%, Xitsonga 4.4%, other 7.2% (2001) Castilian Spanish 74% (official nationwide); Catalan 17%, Galician 7%, Spain Basque 2% (each official regionally) Sinhala 74% (official and national), Tamil 18% (national), other 8%; English is Sri Lanka commonly used in government and spoken competently by about 10% Arabic (official), Nubian, Ta Bedawie, diverse dialects of Nilotic, Nilo-Hamitic, Sudan Sudanic languages, English Dutch (official), Surinamese (lingua franca), English widely spoken, Suriname Hindustani, Javanese Swaziland English, siSwati (both official) Sweden Swedish, small Sami- and Finnish-speaking minorities Switzerland German 64%, French 20%, Italian 7% (all official); Romansch 0.5% (national) Arabic (official); Kurdish, Armenian, Aramaic, Circassian widely understood; Syria French, English somewhat understood Taiwan Chinese (Mandarin, official), Taiwanese (Min), Hakka dialects Tajikistan Tajik (official), Russian widely used in government and business Tanzania Swahili, English (both official); Arabic; many local languages Thai (Siamese), English (secondary language of the elite), ethnic and regional Thailand dialects French (official, commerce); Ewé, Mina (south); Kabyé, Dagomba (north); and Togo many dialects Tonga Tongan (an Austronesian language), English Trinidad and Tobago English (official), Hindi, French, Spanish, Chinese Tunisia Arabic (official, commerce), French (commerce) Turkey Turkish (official), Kurdish, Dimli, Azeri, Kabardian Turkmenistan Turkmen 72%; Russian 12%; Uzbek 9%, other 7% Tuvalu Tuvaluan, English, Samoan, Kiribati (on the island of Nui) English (official), Ganda or Luganda, other Niger-Congo languages, Nilo- Uganda Saharan languages, Swahili, Arabic Ukraine Ukrainian 67%, Russian 24%, Romanian, Polish, Hungarian United Arab Emirates Arabic (official), Persian, English, Hindi, Urdu United Kingdom English, Welsh, Scots Gaelic United States English 82%, Spanish 11% (2000)
34
Uruguay Spanish, Portunol, or Brazilero Uzbekistan Uzbek 74.3%, Russian 14.2%, Tajik 4.4%, other 7.1% Bislama 23% (a Melanesian pidgin English), English 2%, French 1% (all 3 Vanuatu official); more than 100 local languages 73% Vatican City (HolySee) Italian, Latin, French, various other languages Venezuela Spanish (official), numerous indigenous dialects Vietnamese (official); English (increasingly favored as a second language); Vietnam some French, Chinese, Khmer; mountain area languages (Mon-Khmer and Malayo-Polynesian) Western Sahara Hassaniya Arabic, Moroccan Arabic (proposed state) Yemen Arabic English (official); major vernaculars: Bemba, Kaonda, Lozi, Lunda, Luvale, Zambia Nyanja, Tonga; about 70 other indigenous languages Zimbabwe English (official), Shona, Ndebele (Sindebele), numerous minor tribal dialects
Source: Information Please® Database, © 2007 Pearson Education
The following is a brief list of the correct terminology to be used in official correspondence.
Avoid Use Instead Afghan Persian Dari Cambodian Khmer Chinese Specify if Cantonese, Mandarin, Hakka, Persian Farsi Indian Specify if Hindi or one of 18 regional languages Indonesian Bahasa Indonesian Lebanese Arabic (Lebanese is not a language) Malay Bahasa Malaysia Maori Specify if Cook Island Maori Siamese Thai Tagalog or Pilipino Filipino
Avoid Use Instead Czechoslovakia Czech Republic; Slovakia Burma Myanmar Byelorussia Belarus USSR or Soviet Union Russian Federation Yugoslavia Bosnia & Herzegovina, Croatia, Former Republic of Macedonia, Slovenia, Serbia & Montenegro
35 Review of deaths – children and young people, and people with disabilities
The Ombudsman is the independent and impartial • people with disabilities who were living in a residential watchdog for community services in NSW. Through his care service authorised or funded under the Disability role, the Ombudsman: Services Act 1993; or • promotes and protects the rights and best interests of • people with disabilities who were living in a licensed consumers of community services in NSW; and boarding house. • assists service providers to meet their obligations under A person’s death is also reviewable if they died while the community welfare legislation. temporarily absent from a residential care service or The Ombudsman carries out his role under the licensed boarding house. Community Services (Complaints, Reviews and Monitoring) Act 1993, the Ombudsman Act 1974 and the Child Death Review Team Commission for Children and Young People Act 1998. The Child Death Review Team, of which the Ombudsman One of the Ombudsman’s roles is to review the deaths of is the convenor, reviews the deaths of all children and certain children, young people and people with disabilities young people (aged under 18 years) in NSW. in care (called ‘reviewable deaths’). The Ombudsman’s Community Services Division carries out these functions, and the Division is headed by the Deputy Ombudsman What is the role of the and Community and Disability Services Commissioner. Ombudsman in reviewing The Ombudsman is also the convenor of the NSW Child Death Review Team, and staff from the Ombudsman’s deaths? offce provide support and assistance to the Team in the exercise of its functions. Common to the review functions described above is the Ombudsman’s focus on developing strategies to prevent The Child Death Review Team consists of the or reduce deaths. Ombudsman; the Deputy Ombudsman and Community and Disability Services Commissioner; the Commissioner for Children and Young People; representatives from the Reviewable deaths Departments of Family and Community Services, Health, The Ombudsman: Education and Communities, Attorney General and • maintains a register of reviewable deaths in NSW Justice, the NSW Police Force, and the Offce of the NSW Coroner; and individuals with expertise in relevant felds. • monitors, reviews and analyses information relating to deaths to identify any emerging trends • makes recommendations about policies and practices Deaths reviewed by the that could be implemented by government and service Ombudsman providers to prevent or reduce deaths; and • conducts research with the aim of developing strategies to reduce or remove risk factors associated with Reviewable deaths reviewable deaths that are preventable. ‘Reviewable deaths’ are defned by the Community The Ombudsman is required to provide a report to the Services (Complaints, Reviews and Monitoring) Act 1993 as: NSW Parliament every two years on the Ombudsman’s work and activities in relation to reviewable deaths. • children who died as a result of abuse or neglect, or in suspicious circumstances • children in care, as defned in the Community Services (Complaints, Reviews and Monitoring) Act 1993 • children who died while in detention
Community Services Fact Sheet 3 Review of deaths – children and young people, and people with disabilities
Child Death Review Team Reviewable deaths The Team: Legislation covering reviewable deaths allows the • maintains the register of child deaths occurring in NSW Ombudsman to report information about a reviewable death, or information arising from review work, to a service • classifes those deaths according to cause, provider or appropriate person or body. demographic criteria and other relevant factors • analyses the information in the register in order to If the Ombudsman thinks it appropriate, the Ombudsman identify trends relating to those deaths; and may give information or copies of documents gained through reviews to certain agencies, public authorities and • undertakes research and makes recommendations as service providers who have a relevant interest in the matter. to legislation, policies, practices and services to prevent or reduce the likelihood of child deaths. Child Death Review Team The Team is required to provide a report to the NSW Parliament every year about its work and activities in In relation to all child deaths, the Child Death Review relation to child death reviews. Team may give information to the: • Commissioner of Police, if the information is in Who notifes deaths to the connection with a possible criminal offence. • Director-General of the Department of Family and Ombudsman? Community Services, where a child or class of children may be at risk of harm. • The Registry of Births, Deaths and Marriages provides the Ombudsman with information about the registered • State Coroner, where the information may relate to a deaths of children in NSW. death that is within the jurisdiction of the Coroner. • Ageing, Disability and Home Care provides the • Domestic Violence Death Review Team, in connection Ombudsman with information about the deaths of with that Team’s functions. children and adults with disabilities in residential care. • The State Coroner’s offce provides the Ombudsman What is the role of the with information about reviewable deaths and the deaths of children that have been notifed to the Coroner. Coroner?
Deaths that are considered reviewable must be notifed What does it mean for to the Coroner. This is generally done through service service providers and other providers or agencies contacting the Police. The Coroner examines each death and will determine the agencies? manner and cause of death, and whether an inquest is necessary. Service providers and other designated bodies, including the NSW Police, Community Services and The State Coroner’s offce also supports the Domestic the State Coroner, must provide the Ombudsman full Violence Review Team. and unrestricted access to relevant records relating to reviewable deaths, and to deaths reviewable by the Child Death Review Team.
Contact us for more information Our business hours are: Monday to Friday, 9am–5pm (Inquiries section closes at 4pm) If you wish to visit us, we prefer you make an appointment. Please call us frst to ensure your complaint is within our jurisdiction and our staff are available to see you.
Level 24, 580 George Street General inquiries 02 9286 1000 Telephone Interpreter Service (TIS): 131 450 Sydney NSW 2000 Facsimile 02 9283 2911 We can arrange an interpreter through TIS or you can contact TIS yourself before Email [email protected] Toll free (outside Sydney metro) 1800 451 524 speaking to us. Web www.ombo.nsw.gov.au Tel. typewriter (TTY) 02 9264 8050
© Crown Copyright, NSW Ombudsman, March 2012 ISBN: 978-1-921131-28-8 03/2012
This work is copyright, however material from this publication may be copied and published by State or Federal Government Agencies without permission of the Ombudsman on the condition that the meaning of the material is not altered and the NSW Ombudsman is acknowledged as the source of the material. Any other persons or bodies wishing to use material must seek permission. This fact sheet is one of a series produced by the NSW Ombudsman. Feedback is welcome. Review of deaths – children and young people, and people with disabilities
The Ombudsman is the independent and impartial • people with disabilities who were living in a residential watchdog for community services in NSW. Through his care service authorised or funded under the Disability role, the Ombudsman: Services Act 1993; or • promotes and protects the rights and best interests of • people with disabilities who were living in a licensed consumers of community services in NSW; and boarding house. • assists service providers to meet their obligations under A person’s death is also reviewable if they died while the community welfare legislation. temporarily absent from a residential care service or The Ombudsman carries out his role under the licensed boarding house. Community Services (Complaints, Reviews and Monitoring) Act 1993, the Ombudsman Act 1974 and the Child Death Review Team Commission for Children and Young People Act 1998. The Child Death Review Team, of which the Ombudsman One of the Ombudsman’s roles is to review the deaths of is the convenor, reviews the deaths of all children and certain children, young people and people with disabilities young people (aged under 18 years) in NSW. in care (called ‘reviewable deaths’). The Ombudsman’s Community Services Division carries out these functions, and the Division is headed by the Deputy Ombudsman What is the role of the and Community and Disability Services Commissioner. Ombudsman in reviewing The Ombudsman is also the convenor of the NSW Child Death Review Team, and staff from the Ombudsman’s deaths? offce provide support and assistance to the Team in the exercise of its functions. Common to the review functions described above is the Ombudsman’s focus on developing strategies to prevent The Child Death Review Team consists of the or reduce deaths. Ombudsman; the Deputy Ombudsman and Community and Disability Services Commissioner; the Commissioner for Children and Young People; representatives from the Reviewable deaths Departments of Family and Community Services, Health, The Ombudsman: Education and Communities, Attorney General and • maintains a register of reviewable deaths in NSW Justice, the NSW Police Force, and the Offce of the NSW Coroner; and individuals with expertise in relevant felds. • monitors, reviews and analyses information relating to deaths to identify any emerging trends • makes recommendations about policies and practices Deaths reviewed by the that could be implemented by government and service Ombudsman providers to prevent or reduce deaths; and • conducts research with the aim of developing strategies to reduce or remove risk factors associated with Reviewable deaths reviewable deaths that are preventable. ‘Reviewable deaths’ are defned by the Community The Ombudsman is required to provide a report to the Services (Complaints, Reviews and Monitoring) Act 1993 as: NSW Parliament every two years on the Ombudsman’s work and activities in relation to reviewable deaths. • children who died as a result of abuse or neglect, or in suspicious circumstances • children in care, as defned in the Community Services (Complaints, Reviews and Monitoring) Act 1993 • children who died while in detention
Community Services Fact Sheet 3 Review of deaths – children and young people, and people with disabilities
Child Death Review Team Reviewable deaths The Team: Legislation covering reviewable deaths allows the • maintains the register of child deaths occurring in NSW Ombudsman to report information about a reviewable death, or information arising from review work, to a service • classifes those deaths according to cause, provider or appropriate person or body. demographic criteria and other relevant factors • analyses the information in the register in order to If the Ombudsman thinks it appropriate, the Ombudsman identify trends relating to those deaths; and may give information or copies of documents gained through reviews to certain agencies, public authorities and • undertakes research and makes recommendations as service providers who have a relevant interest in the matter. to legislation, policies, practices and services to prevent or reduce the likelihood of child deaths. Child Death Review Team The Team is required to provide a report to the NSW Parliament every year about its work and activities in In relation to all child deaths, the Child Death Review relation to child death reviews. Team may give information to the: • Commissioner of Police, if the information is in Who notifes deaths to the connection with a possible criminal offence. • Director-General of the Department of Family and Ombudsman? Community Services, where a child or class of children may be at risk of harm. • The Registry of Births, Deaths and Marriages provides the Ombudsman with information about the registered • State Coroner, where the information may relate to a deaths of children in NSW. death that is within the jurisdiction of the Coroner. • Ageing, Disability and Home Care provides the • Domestic Violence Death Review Team, in connection Ombudsman with information about the deaths of with that Team’s functions. children and adults with disabilities in residential care. • The State Coroner’s offce provides the Ombudsman What is the role of the with information about reviewable deaths and the deaths of children that have been notifed to the Coroner. Coroner?
Deaths that are considered reviewable must be notifed What does it mean for to the Coroner. This is generally done through service service providers and other providers or agencies contacting the Police. The Coroner examines each death and will determine the agencies? manner and cause of death, and whether an inquest is necessary. Service providers and other designated bodies, including the NSW Police, Community Services and The State Coroner’s offce also supports the Domestic the State Coroner, must provide the Ombudsman full Violence Review Team. and unrestricted access to relevant records relating to reviewable deaths, and to deaths reviewable by the Child Death Review Team.
Contact us for more information Our business hours are: Monday to Friday, 9am–5pm (Inquiries section closes at 4pm) If you wish to visit us, we prefer you make an appointment. Please call us frst to ensure your complaint is within our jurisdiction and our staff are available to see you.
Level 24, 580 George Street General inquiries 02 9286 1000 Telephone Interpreter Service (TIS): 131 450 Sydney NSW 2000 Facsimile 02 9283 2911 We can arrange an interpreter through TIS or you can contact TIS yourself before Email [email protected] Toll free (outside Sydney metro) 1800 451 524 speaking to us. Web www.ombo.nsw.gov.au Tel. typewriter (TTY) 02 9264 8050
© Crown Copyright, NSW Ombudsman, March 2012 ISBN: 978-1-921131-28-8 03/2012
This work is copyright, however material from this publication may be copied and published by State or Federal Government Agencies without permission of the Ombudsman on the condition that the meaning of the material is not altered and the NSW Ombudsman is acknowledged as the source of the material. Any other persons or bodies wishing to use material must seek permission. This fact sheet is one of a series produced by the NSW Ombudsman. Feedback is welcome. NSW Police Service
Dear
RE: NSW Police notification of death of a person in an ADHC service.
I write to formally notify you of the death of
At the time of their death this person was at
It is mandatory that the death of a person who, at the time of their death, is living in an ADHC funded or operated service or an Assisted Boarding House under Part 4 of the Boarding Houses Act 2012, is reported to the Police and State Coroner in accordance with the Coroners Act 2009 s24(1)(e) and s35(2). This includes a person who, at the time of death, was temporarily absent from an ADHC operated or funded accommodation support service, centre based respite or an Assisted Boarding House, for example, in hospital, a hospice or staying with family.
I hope that this information is of assistance. If you require further detail, please contact
Yours sincerely
NSW Police Service
Dear
RE: NSW Police notification of death of a person in an ADHC service.
I write to formally notify you of the death of
It is mandatory that the death of a person who, at the time of their death, is living in an ADHC funded or operated service or an Assisted Boarding House under Part 4 of the Boarding Houses Act 2012, is reported to the Police and State Coroner in accordance with the Coroners Act 2009 s24(1)(e) and s35(2).
I hope that this information is of assistance. If you require further detail, please contact
Yours sincerely
NSW State Coroner Coroners Court PO Box 309 CAMPERDOWN NSW 1450
Dear
I write to formally notify you of the death of
At the time of death this person was at
It is mandatory that the death of a person who, at the time of their death, is living in an ADHC funded or operated service or an Assisted Boarding House under Part 4 of the Boarding Houses Act 2012, is reported to the Police and State Coroner in accordance with the Coroners Act 2009 s24(1)(e) and s35(2). This includes a person who, at the time of death, was temporarily absent from an ADHC operated or funded accommodation support service, centre based respite or an Assisted Boarding House, for example, in hospital, a hospice or staying with family.
I hope that this information is of assistance. If you require further detail, please contact
Yours sincerely
NSW State Coroner Coroners Court PO Box 309 CAMPERDOWN NSW 1450
Dear
I write to formally notify you of the death of
It is mandatory that the death of a person who, at the time of their death, is living in an ADHC funded or operated service or an Assisted Boarding House under Part 4 of the Boarding Houses Act 2012, is reported to the Police and State Coroner in accordance with the Coroners Act 2009 s24(1)(e) and s35(2).
I hope that this information is of assistance. If you require further detail, please contact
Yours sincerely
Operational Guidelines for the Review of the Death of People with Disability
A guide for the review of the death of a person residing in a FACS operated accommodation or centre-based respite service
Document version control
Distribution: Disability Operations staff
Document name: The Operational Guidelines for the review of the death of people with disability
Approved by:
Version: Version 1.0
Document status: Draft
Summary: The Operational Guidelines provide guidance and support to disability operational staff with regard to the review of
the death of a person with a disability residing in FACS direct services
Authoring unit: Performance Improvement
Date: February 2017
Operational Guidelines for the Review of the Death of People with Disability February 2017 2
Table of Contents 1 Purpose of these Guidelines ...... 4 2 Legislative Requirements and Mandatory Reporting Obligations ...... 4 3 Expected or Unexpected Death ...... 5 4 Internal Reviews and Investigations ...... 5 5 Responding to the death of a person – Summary…………………………………………8 5.1 Response Area A Review of a death of a person……………...12 5.2 Response Area B 6 Definitions ...... 16 7 Index of Templates ...... 16 8 Appendices ...... 16
Operational Guidelines for the Review of the Death of People with Disability February 2017 3
1 Purpose of these Guidelines
The purpose of these guidelines is to outline the investigation and review requirements to be undertaken following the death of a person with a disability in FACS operated services. The internal review procedure is designed to lead to meaningful systemic change and practice improvement at a local and state- wide level.
These guidelines are applicable to all FACS operated accommodation services (including LRC-SSL, In-Home Support), centre-based respite, Integrated Services Program (ISP) and Community Justice Program (CJP). These guidelines must be read in conjunction with the following ADHC policies and guidelines:
• ADHC Death Procedures • ADHC Incident Reporting and Management Policy and Guidelines for Ageing and Disability Direct Services
2 Legislative Requirements and Mandatory Reporting Obligations
Under the Coroners Act 2009, FACS operated services must report the death or suspected death of a person with disability, to NSW Police and State Coroner. This requirement also applies to ADHC funded non-government disability accommodation support services and assisted boarding house1.
Mandatory reporting requirements of a death or suspected death of a person with disability to the NSW Ombudsman under the Community Services (Complaints, Reviews and Monitoring) Act 1993 applies to both FACS operated and FACS (ADHC) funded non-government accommodation support services as well as assisted boarding houses.
All staff have a legal duty to provide assistance to an unresponsive person under the Crimes Act 1900.
The NSW Ombudsman maintains a register of reviewable deaths, and analyses information about causes of death and any patterns or trends arising from the register. The NSW Ombudsman also undertakes research and makes recommendations for the purpose of reducing or removing risk factors associated with reviewable deaths that are preventable.
1 Refer to ADHC Death Procedures (p.6)
Operational Guidelines for the Review of the Death of People with Disability February 2017 4
‘All deaths of people with disability who live in residential care or an assisted boarding house must be notified to the NSW Ombudsman within 30 days2’.
FACS must notify all deaths. Disability services (Accommodation services, including Group Homes, In-Home Support, Large Residential Centres and Specialist Supporting Living, Centre-Based Respite, Integrated Services Program and Community Justice Program) are required to complete the Client Death Notification (CDN) and submit the form and key documents to the relevant Executive Director Disability Operations and the Deputy Secretary, Disability Operations within 24-48 hours of the person’s death. This information will then be forwarded to Performance Improvement.
Both the NSW Coroner and the NSW Ombudsman can formulate recommendations as to policies and practices to be implemented by Government for the prevention or reduction of future deaths.
3 Expected or Unexpected Death
In FACS operated accommodation and centre-based respite disability services, a person’s death is classified as a Category 13 and is either expected or unexpected either expected or unexpected. These are defined4 as:
• expected death – the person has a progressive, advanced disease or terminal illness and a treatment or palliative care/end of life plan, or the person chooses not to pursue curative treatment.
• unexpected death – when a person dies suddenly and unpredictably.
In completing the Client Death Notification (CDN) form5, the support worker and Manager make a determination on whether the death was Expected or Unexpected.
4 Internal Reviews and Investigations
As stated under the Legislative requirements and Reporting Obligations section (section 2), the NSW Ombudsman reviews the deaths of people with disabilities and maintains a register of reviewable deaths. FACS has a policy of reviewing all deaths when the person was residing in disability operations direct services. This review is provided to the NSW Ombudsman. The aim of the review is to determine whether: the service response was reasonable in the circumstances; the clinical practice and supports were comprehensive and
2 NSW Ombudsman website- Reviewable Deaths 3 The Incident Management Policy and Guidelines are currently being amended to reflect the Cat 1 status 4 Refer to ADHC Death Procedures (p.18, 32 & 34) 5 Refer to page 9 of this document
Operational Guidelines for the Review of the Death of People with Disability February 2017 5
appropriate; any inaction that could be considered a misconduct matter; and whether there are any learnings that may prevent further deaths. FACS must review all deaths when the person was living in disability operated direct services, whether they were at their usual residence or temporarily absent (for example on holidays, in hospital or in the community, in aged-care or where the person has not formally exited from their accommodation service) .
This internal review process is independent of any external inquiry into the cause of death (such as a coronial investigation or review by the NSW Ombudsman).
An internal review will occur for both expected and unexpected deaths. The requirements of a review are outlined below:
Expected Death6 Step 1: District/LRC-SSL conducts a local independent review of the information on the person’s death to identify gaps in policy, practice, services, dignity issues and risks.
Step 2: District/LRC-SSL prepares an action plan based on review findings and recommendations.
Step 3: The action plan is submitted to Executive Director, Disability Operations and Director, Disability who then provide copies to the Deputy Secretary, Disability Operations and Performance Improvement. Performance Improvement will monitor progress on action items via status updates. This team will work with the district/LRCSSL to Fact Finding establish an agreeable reporting schedule on the identified Template recommendations.
Unexpected Death
Step 1: The Director Disability contacts Clinical Innovation and Governance (CIG) to request a clinical review and identifies a local staff person who is independent of the unit, to conduct a local fact finding. Similarly, LRC-SSL conducts a clinical review and identify a local staff person who is independent of the unit, to conduct a fact finding.
Step 2: CIG and LRC-SSL conduct a Clinical Review and District/LRC-SSL conducts an ‘independent’7 fact finding.
Step 3: Professional Conduct and Employee Performance (PCEP) authorises an investigation of any identified or potential staff misconduct matters - where these matters have been identified through the fact finding.
6 Refer to page 12 for further guidance 7 Preferably a staff person who is not directly aligned to the affected service.
Operational Guidelines for the Review of the Death of People with Disability February 2017 6
Step 4: The CIG/LRC-SSL Review and the fact finding report is submitted to the Director Disability and the respective Executive Director, Disability Operations who then provide copies to the Deputy Secretary, Disability Operations. The Performance Improvement (PI) and CIG receive copies for the Critical Incidents Review Panel and for action (PI) in relation to systemic risks and issues and monitoring of actions and recommendations.
Step 5: The District/LRC-SSL prepares an action plan based on the recommendations of the clinical review review and fact finding report/s. The action plan is submitted to Executive Director, Disability Operations and Director, Disability who then provide copies to the Deputy Secretary, Disability Operations and Performance Improvement. Performance Improvement will monitor progress on action items via status updates. This team will work with the district/LRCSSL to establish an agreeable reporting schedule on the identified recommendations.
Step 6: The District/LRCSSL and PCEP follow the prescribed process to progress and finalise employee misconduct matters where these matters have been identified through the fact finding process or investigation. Where broad findings or recommendations are made in relation to PCEP matters, this information will be included in the District/LRCSSL’s action plan.
Operational Guidelines for the Review of the Death of People with Disability February 2017 7
5 Responding to the death of a person – Summary
5.1 Response Area A The ADHC Death Procedures comprehensively covers the following response areas:
Person is unresponsive/Death of Step 1: Support worker immediately applies First Aid and CPR call Triple a person zero (00)and ask for an ambulance Immediate Response and within Step 1.1: If the person has a current Authorised Plan that contains treatment 1-2 hours decisions, the caller must provide this advice to the 000 operator. Continue first aid until ambulance arrives
Step 2: Support worker notifies Management. Management verbally notifies Director and Executive Director
Summary 8
Step 3: Manager notifies next of kin or guardian -
A
Step 4: Manager reports the person’s death to the NSW Police, NSW State Coroner and Work Cover
Step 1: Support worker/s & Manager complete the Incident Report, Category 1 form and Client Death Notification Form
Response Area Death of a person Response within 24 to 48 hours Step 2: Manager collates key client plans and documents
Step 3: Manager prepares Briefing Note
Step 1: Performance Improvement report the death to the NSW Ombudsman
Death of a person Response 48 hours after death Step 2: Performance Improvement notifies other FACS internal or external services as required
In summary, Death of a person – Immediate response and within 1-2 hours
Upon discovering a person who is not breathing and or has no pulse, staff should:
Step 1: Immediately Call Triple zero (000) and ask for an ambulance • Administer first aid and CPR until ambulance services take over • Always call an ambulance • Only then call the manager/on call manager • If the manager does not answer, call the Director Disability
8 If the person is admitted to hospital, notify the relevant manager and person’s family
Operational Guidelines for the Review of the Death of People with Disability February 2017 8
Step 2: Notify management
The death of a person, or where a person has been found unresponsive, must be reported to the manager or after hours on call manager immediately. The Manager, or equivalent, informs the Director Disability/Director LRC/SSL who then verbally notifies the Executive Director, Disability Operations. Brief dot points are then to be sent to the ED covering: name of the deceased, DOB, location of residence/service, known circumstances of the death, confirmation that the person responsible has been notified. The Executive Director notifies Deputy Secretary, Disability Operations AND Director, Performance Improvement
Step 3: Notify next of kin
The Manager or Director Disability/Director, LRC/SSL is responsible for notifying the deceased person’s next of kin or guardian. This can be delegated to a more appropriate staff person, where appropriate. While not always possible, notification is preferably done in person. Note: refer to the ADHC Death Procedures regarding the specific protocol for notifying when an Aboriginal or Torres Straight Islander person dies and notifying next of kin.
The following information is to be provided to the next of kin or guardian: • When and where the person died/was unresponsive • That support is available to them • That the death will be reported to the NSW and State Coroner • The death will be reported to the NSW Ombudsman
Step 4: Report the person’s death to the NSW Police, NSW State Coroner and Work Cover
The Manager ensures that the person’s death is reported to the local NSW Police, and that they understand the death is reportable under the Coroner’s Act 2009 s24.
Managers are to ensure that standard letters are sent to the NSW Police and the State Coroner regarding the person’s death. The Work Health and Safety Act 2011 require that Work Cover be notified immediately of deaths and serious incidents that occur in the workplace.
Operational Guidelines for the Review of the Death of People with Disability February 2017 9
Death of a person – response within 24-48 hours
Step 1: Complete Incident Report, Category 1 form and Client Death Notification Form
a. Complete documentation, scan and forward to:
Executive Director, Disability Operations North/South [email protected] [email protected]
b. Executive Director sends to:
Performance Improvement [email protected]
c. Performance Improvement sends to: Deputy Secretary, Disability Operations and other key stakeholders
The support worker/s present during the incident and the manager who was notified at the time of the person’s death are to complete the Client Death Notification Form (CDN), Incident Report and Cat 1 form. Information on the wellbeing of the person and the events leading up to the person’s death must be reflected in these documents.
Step 2: Collate key client documents and plans
The Manager forwards the Client Death Notification Form (CDN), Incident Report, Category 1 and key client information (for example: Nutrition and Swallowing Checklist, Health Care Plan, My Safety Plan, Epilepsy Management Plan, Allied Health Specialist Reports, Mealtime Management Plan, Asthma and/or Treatment Plans, if applicable) to Performance Improvement.
Step 3: Prepare Briefing Note for Unexpected Deaths
A Briefing Note is prepared by the relevant Manager and submitted to the Director, Disability and Executive Director, Disability Operations. The signed Briefing Note is then forwarded to Performance Improvement who then forwards to Deputy Secretary, Disability Operations. The ADHC Death Procedures advises on the information to be included in the briefing note9.
9 ADHC Death Procedures (p.19)
Operational Guidelines for the Review of the Death of People with Disability February 2017 10
The briefing note must include information on the wellbeing of the person and the events leading up to the person’s death.
Death of a person – 48 hours after the death
►Information distributed by Performance Improvement to key stakeholders, including the NSW Ombudsman Performance Improvement notifies the NSW Ombudsman’s office of an unexpected death by telephone. The timing of this notification is generally when Performance Improvement are informed of the death.
Performance Improvement distributes the key information (CDN, Incident Report and Cat 1) by email to the relevant internal and external business units (Reportable Incident Team (where appropriate), Service Improvement Unit, Governance and Audit, Clinical Innovation & Governance, Legal and NSW Ombudsman).
Operational Guidelines for the Review of the Death of People with Disability February 2017 11
Review of a death of a person
Steps for the review of a death of a person
5.2 Response Area B
Immediate review process Step 1: Review Process following death
Step 2: Review Recommendations
Summary Summary Step 1: Unit level - Implementation of Recommendations
-
B Implementation of Report Recommendations Step 2: District/LRC/SSL level - Communication and Implementation of Recommendations
State Wide Practice Step 1: Systemic Analysis and Recommendations Improvement Response Area Area Response
Immediate review process following a death
Step 1: Internal Review Process
Internal Review process for an unexpected death
Internal investigations into unexpected deaths in FACS operated accommodation and centre-based respite services include a clinical management review10 which is conducted by Clinical Innovation and Governance (CIG). This review analyses the clinical supports and governance that were provided to the person against the prescribed organisational standards and policy.
Generally an ‘independent fact finding investigation’ of the death of the person is also undertaken. This is an inquiry into the circumstances leading up to the death and will also consider whether there are any professional conduct issues warranting investigation by Professional Conduct, Ethics and Performance Unit (PCEP). The relevant District/LRC/SSL instructs an internal independent staff person to undertake the investigation. If potential staff
10 Refer to the Clinical Governance Reviews, Business Rules and the Clinical Governance Reviews, Procedures (2015)
Operational Guidelines for the Review of the Death of People with Disability February 2017 12
misconduct issues are identified, PCEP will then arrange for an external investigation on behalf of the District/LRC/SSL.
Considering must be given to the following prior to any review:
• Clarification of roles and responsibilities across FACS taking into consideration the individual circumstances of the death. • Identification of issues that may arise as a result of any internal and external investigations being conducted simultaneously into the same death (for example cases where internally gathered information may be requested to inform external investigations). • The timing of the completion of a comprehensive clinical governance review by CIG11, the local fact finding and PCEP investigation (where required). • Consideration as to whether an external review is required in circumstances of complexity to investigate possible systemic issues.
Review process for an expected death
When an expected death occurs, the death is reviewed by a local clinician or Manager who is not working directly with the related service. This involves an analysis of relevant documents such as the CDN, Treatment Plan and treatment decisions, to identify any improvements to the care provided to the person prior to death, and to evaluate compliance with all relevant end of life policies, procedures and practice.
Step 2: Review Recommendations
The CIG review and local fact finding is instigated by the District/LRC/SSL. PCEP commission an investigation where matters of professional conduct are the focus.
Reports arising from the investigation process are reviewed locally by the Director, Disability. Copies of the reports/action plans are then forwarded to the Executive Director and Director, Performance Improvement. The findings and/or recommendations of the reports are to be distributed locally as appropriate. It is critical to the practice improvement process that relevant staff, receive feedback on the review and understand the recommendations and actions being undertaken in response to the report findings and/or recommendations. It would also be prudent to provide staff with information on the EAPS service following these discussions.
Performance Improvement will send relevant information to CIG for the Critical Incidents Review Panel. This panel meets bi monthly to consider any
11 Refer to Clinical Governance Reviews, Business Rules and the Clinical Governance Reviews, Procedures (2015)
Operational Guidelines for the Review of the Death of People with Disability February 2017 13
deaths that have occurred in the District/LRC/SSLs. The purpose of this panel is to provide an objective analysis of the events leading up to the death which may then inform practice improvement12 and identify/ report trends and critical issues associated with the deaths. The Critical Incidents Review Panel review one or two client deaths and related information each meeting.
The Director Disability will be invited to participate to discuss any policy and practice gaps that the panel identifies and how the risks are being managed what remedial action is occurring. This examination (the district’s own view) of the circumstances of the death and how FACS can learn from these events and reduce or remove risk factors associated with deaths more broadly.
Implementation of Report Recommendations
Step 1: Unit level - Implementation of Recommendations
This step provides opportunities for the prompt implementation of any recommendations arising from the review process within the unit where the death occurred. The focus will be on practice improvement changes that can be applied immediately to improve the safety and wellbeing of the people residing in the unit.
• The Director, Disability informs the relevant Manager A&R, Coordinator A&R and the Team Leader (or equivalent) of the recommendations and considerations resulting from the ADHC internal death review process. • An Action Plan based on the recommendations and findings is prepared. • A copy of the Action Plan is provided to the Performance Improvement. Performance Improvement will work with the relevant District/LRC/SSL to establish an agreeable reporting regime on the action implementation. • The Team Leader then briefs their team on the recommendations, considerations and agreed Action Plan.
Step 2: District level - Communication and Implementation of Recommendations
This step ensures that any immediate lessons learned from a person’s death are then shared with the District/LRC/SSL by providing recommendations and considerations arising from the internal death review process.
• The Director, Disability informs all Managers, Co-ordinators A&R and relevant Community Support Team Managers (or equivalent) of the recommendations and considerations arising from the internal death review process.
12 Refer to the Clinical Review Panel Terms of Reference, CIG (2015)
Operational Guidelines for the Review of the Death of People with Disability February 2017 14
• Managers A&R and Co-ordinators use the information to implement improvements across all A&R services. • System Support Analysts (or equivalent) are to conduct spot audits of the recommendations across all District/LRClSSL A&R services (where appropriate). Audit findings and proposed actions and timeframes are reported to the Director, Disability/LRC/SSL.
State-Wide Practice Improvement
Step 1: Systemic Analysis and Recommendations
This step identifies the broader systemic issues that may not have been detected in the internal death review process, and/or those issues which may have been identified but which due to their complexity require further consultation and consideration before recommendations can be made.
• Performance Improvement will review the recommendations and findings for state-wide impact and immediate response, where applicable. • The Critical Incidents Review Panel will analyse the findings, identify trends and critical issues and make recommendations for practice improvement. • The Critical Incidents Review Panel then forwards recommendations to Performance Improvement to facilitate the implementation of identified improvement strategies and for analysis and identification of broader systemic issues.
Operational Guidelines for the Review of the Death of People with Disability February 2017 15
6 Definitions
The table below is a list of terms, keywords and/or abbreviations used throughout this document.
Term Definition
ISP Integrated Services Program
CJP Criminal Justice Program
LRC/SSL Large Residential Centres and Specialist Supported Living
PCEP Professional Conduct and Employee Performance
PI Performance Improvement
CIG Clinical Innovation and Governance
CST Community Support Team
CDN Child Death Notifications
7 Index of Templates
Fact finding report template
8 Appendices
Appendix 1 – Flow chart of death review procedures Appendix 2 – Fact finding process and template Appendix 3 – Local fact finding investigation report example
Operational Guidelines for the Review of the Death of People with Disability February 2017 16 Other resources
Death
1. Legislation 2. Policy links 3. NSW Ombudsman 4. NSW State Coroner 5. Resources for Aboriginal and Torres Strait Islander people 6. Bereavement resources 7. Deceased estates 8. Language services 9. Link to ELMO e-learning module 10. Law and Justice contact details
Death, Other Resources, V1.0, January 2016 1 1 Legislation Boarding House Act 2012, Boarding House Regulation 2013 Community Services (Complaints, Reviews and Monitoring) Act 1993 Coroners Act 2009 Crimes Act 1900 S44 Disability Inclusion Act 2014 Part 3C Ombudsman Act 1974 Work Health and Safety Act 2011 2 Policy Links FACS Incident Reporting and Management Policy for people accessing Ageing and Disability Direct Services November 2014 FACS Incident Reporting and Management Guidelines for people accessing Ageing and Disability Direct Services November 2014 Code of Ethical Conduct, September 2013 End of Life Care Planning Guidelines 2015 FACS Aboriginal Strategy 2013-2015 FACS Aboriginal Strategy 2013-2015 FACS Aboriginal Cultural Inclusion Framework 2015-2018 FACS Community Complaints Policy for Ageing and Disability Direct Services, September 2014 FACS Community Complaints Guidelines for Ageing and Disability Direct Service, September 2014 FACS Cultural Diversity Framework 2014 – 2017 FACS Statement of Commitment Risk and Safety Policy 2015 Service Charter of Standards for Aboriginal Clients 3 NSW Ombudsman Reviewable Disability Deaths: Frequently Ask Questions http://www.ombo.nsw.gov.au/__data/assets/pdf_file/0006/3885/IS_CSD_Reviewa ble_Disability_Deaths_FAQ.pdf Guidelines for Services – Reportable incidents in disability supported group accommodation https://www.ombo.nsw.gov.au/__data/assets/pdf_file/0014/20534/Guide-for- services-Reportable-incidents-in-disability-supported-group-accommodation.pdf
Death, Other Resources, V1.0, January 2016 2 4 NSW State Coroner State Coroner contact details http://www.coroners.justice.nsw.gov.au/coroners/contact_us.html NSW State Coroners Court - A guide to services, NSW Attorney General & Justice The brochure aims to help you by answering common question about the coronial process. http://www.coroners.lawlink.nsw.gov.au/agdbasev7wr/_assets/coroners/m401601l 1/coroners%20ct%20brochure_110512.pdf Coroners Counselling Services Qualified counsellors are available to assist relatives and friends of the deceased person. They provide information, support and counselling Telephone Glebe (02) 8584 7777 Newcastle (02) 4922 3700 5 Resources for Aboriginal and Torres Strait Islander people Sad news and Sorry Business http://www.healthinfonet.ecu.edu.au/key-resources/bibliography/?lid=21898 Aboriginal Indigenous Health InfoNet http://www.healthinfonet.ecu.edu.au/key- resources/bibliography?page=3&q=&q_exact=&q_author=&q_keyword=&sorter=y ear- Aboriginal Health and Medical Research Council of NSW http://www.healthinfonet.ecu.edu.au/key-resources/organisations?oid=482 The NSW Aboriginal Lands Council – provide assistance, both financial and information regarding funeral services http://www.alc.org.au/nswalc-in-the-community/funeral-fund.aspx Aboriginal Indigenous Health InfoNet http://www.healthinfonet.ecu.edu.au/health-facts/deaths Advance Care Plans and the law – do ambulance paramedics have to follow Advance Care Directives http://healthlaw.planningaheadtools.com.au/advance-care-plans-and-the-law/ 6 Bereavement resources Death and Bereavement services – NSW Government site http://www.service.nsw.gov.au/transaction/death-and-bereavement Good Grief – Growing through change – bereavement services directory https://www.goodgrief.org.au/links
Death, Other Resources, V1.0, January 2016 3 The Bereavement Care Centre http://www.bereavementcare.com.au/services_adults.htm Employment Assistance Program Scheme – EAPS http://dadhc- intranet.nsw.gov.au/working/my_employment/staff_support_programs/employee_a ssistance_program http://www.convergeinternational.com.au/ Managing Grief Better: People with Intellectual Disability, Professor Shelia Hollins http://www.intellectualdisability.info/mental-health/managing-grief-better-people- with-intellectual-disabilities Supporting People Through Loss and Grief, An Easy-to-read booklet, http://www.scopevic.org.au/index.php/cms/frontend/resource/id/130 Grieving as a family – finding comfort together (resource for children, young people and families) http://www.sesamestreet.org/parents/topicsandactivities/topics/grief Destitute Persons – Cremation or Burial http://www0.health.nsw.gov.au/policies/pd/2008/pdf/PD2008_012.pdf 7 Deceased estates Deceased estates – NSW Trustee and Guardian Fact Sheet https://www.tag.nsw.gov.au/verve/_resources/FM_Fact_Sheet_13_Deceased_Est ates_2012.pdf 8 Language services ADHC Language Service Guidelines http://www.adhc.nsw.gov.au/__data/assets/file/0007/237274/LS_Guidelines_May_ 2012.pdf 9 Link to ELMO e-learning module Good to Great Live Portal URL: http://www.elearn.com.au/adhc/goodtogreat Username: adhc Password: goodtogreat 10 Law and Justice contact details Mail: [email protected]
Death, Other Resources, V1.0, January 2016 4 SUPPORTING PEOPLE WITH DISABILITIES COPING WITH GRIEF AND LOSS An easy-to-read booklet
HREPSIME GULBENKOGLU 20 07 ACKNOWLEDGEMENTS T e author would like to first acknowledge the contribution of the many people with disabilities who over the years have shared their very personal experiences which have provided the basis for this booklet. T e author would specially like to thank Dr Nick Hagiliassis for his ongoing input and support in the development and publication phases of this booklet. T anks to Helen Larkin and Merrin McCracken for their support in the inception and early development phases and to Joanne Watson for her support with the easy English aspects of this publication. She would also like to extend her appreciation to the members of the Bridging Project and Statewide Specialist Services team at Scope for their support along the way. Finally, the author would like to acknowledge the donor support of Ms Barbara Haynes. ISBN: 978-0-9757076-5-4
Disclaimer: T is booklet has been developed for clients and carers who support people with disabilities to deal with grief and loss. It has been developed based on information from available research and clinical publications as well as clinical experience based on working with people with disabilities. However, the material is not definitive or exhaustive. Attention has been given to ensure that the information included in this booklet is relevant to many people with disabilities and complex communication needs. However, decisions regarding seeking specific therapeutic services remain the responsibility of the person and/or their carer and/or their advocate. T e information provided through this publication is not intended to provide or substitute for professional mental health services or advice, including grief counselling or therapy. In no event shall the author or the various collaborators be liable for any damages or consequences resulting from direct, indirect, correct or incorrect use of this booklet.
Copyright © Scope (Vic) Ltd 2007 Published by Scope (Vic) Ltd, 830 Whitehorse Road, Box Hill, Melbourne, AUSTRALIA, 3128 Background and using pictures. T is section provides information about grief and loss, and strategies Te aim of this booklet is: for dealing with grief, in an easy-to-read format.
• To provide people with disabilities and their T is resource makes use of pictures that have been support people with an overview and an developed to aid understanding and expression understanding of the grief process. for people with a range of communication and • To highlight the range of needs of people cognitive abilities. T ey have been designed with disabilities who may be grieving. specifi cally for this publication, in consultation with people with disabilities, by a graphic • To provide eff ective strategies for supporting designer. It is felt that these pictures most people with disabilities in dealing with grief accurately represent the concepts associated and loss. with grief and loss. However, some users of this resource may be familier with and therefore Why this booklet? more comfortable with commercial symbol It is imperative that all people have access to sets. If this is the case, they are encouraged to appropriate supports, where required and supplement it with the symbols/pictures they are where requested, for dealing with grief and loss. most comfortable with. People with disabilities, may require additional T e second section has been developed for supports that are sensitive to and cater for their people who support people with disabilities to specific needs. T e provision of appropriate deal with grief and loss. T ey are written as support needs to take into account the social guidelines that may be helpful to families and factors, cognitive factors and communication service providers who wish to actively assist the factors, that may have an impact on how grieving person with disability. a person with a disability experiences and expresses grief and loss. How to use this booklet.
Tis booklet has been written with the needs T is booklet maybe used in several ways: of people with disabilities in mind and includes information and strategies that will be readily • As a photocopiable resource in its entirety accessible to many people. or in sections. • By the person with a disability, independently Who is this booklet for? or with support. • By support people as a resource to build T is booklet is organised in two sections. T e their awareness and capacity in this area. first section has been developed for people with disabilities themselves, written in easy English
SUPPORTING PEOPLE WITH DISABILITIES COPING WITH GRIEF AND LOSS
Easy-to-read information
CONTENTS Easy-to-read information What is grief? 4 What is a major loss? 5 Cycle of life 6 Why do people die? 7 When people are alive... 8 When people are dead... 9 A Funeral 10 When someone dies... 11 Changes in thinking 12 Changes in behaviour 14 Changes in our bodies 15 Normal feelings 16 It’s OK... 17 Special days 18 What helps 19 Other ideas that may help 20 Keeping reminders 22
Information for support people 25 to 36 What is grief?
Grief is what we may feel after a major loss.
4 COPING WITH GRIEF AND LOSS – Easy-to-read information A major loss could be:
Someone dying
A pet dying
A relationship ending
An important life goal not being reached
Not being able to do the things you used to
COPING WITH GRIEF AND LOSS – Easy-to-read information 5 The cycle of life
All living things:
Are born
Grow
B Die
6 COPING WITH GRIEF AND LOSS – Easy-to-read information Why do people die?
Some people get very old and die.
Some people die after an accident.
Some people die because they are very sick.
But not all people who get sick die. Most people get well.
COPING WITH GRIEF AND LOSS – Easy-to-read information 7 When people are alive they can:
Breathe
Communicate
Move
Feel
8 COPING WITH GRIEF AND LOSS – Easy-to-read information When people are dead they:
Breathing
Communicating
Moving
Feeling
COPING WITH GRIEF AND LOSS – Easy-to-read information 9 A Funeral
A funeral is a get-together when someone dies.
People come together to remember and talk about the person they loved.
They may sing songs and say prayers.
It usually helps to go to the funeral, but it is OK if you don’t want to go.
10 COPING WITH GRIEF AND LOSS – Easy-to-read information When someone dies you may have many different feelings. You may feel: r
Sad Like you did something wrong
Angry Upset
Lonely Confused
COPING WITH GRIEF AND LOSS – Easy-to-read information 11 Your thinking may change. You may:
Find it hard to concentrate
Feel confused
Find it hard to make decisions
12 COPING WITH GRIEF AND LOSS – Easy-to-read information You may have thoughts, like:
“It’s not true”
“Why me?”
“I feel scared and lonely.”
“I will never get over this.” “Am I always going to feel like this?”
COPING WITH GRIEF AND LOSS – Easy-to-read information 13 You may behave differently. You may:
Spend time on Get angry your own with others
Lose interest in things Cry more
Eat less Eat more
Sleep less Sleep more
14 COPING WITH GRIEF AND LOSS – Easy-to-read information Your body may be affected. You may:
Get headaches
Feel pain
Feel sick
Find it hard to breathe
Feel tired
COPING WITH GRIEF AND LOSS – Easy-to-read information 15 During grief it’s normal to have these feelings, thoughts, behaviours and bodily sensations.
Give yourself time and you may start to feel better.
16 COPING WITH GRIEF AND LOSS – Easy-to-read information It’s OK It’s OK to:
Have lots of different feelings
Cry
Talk about it if you want
Not talk about it if you don’t want
COPING WITH GRIEF AND LOSS – Easy-to-read information 17 Special days: You may feel sad on special A anniversaries and special days like Christmas and Birthdays.
It’s OK to have sad days.
Give yourself time.
It usually gets easier.
18 COPING WITH GRIEF AND LOSS – Easy-to-read information What helps? Always remember there are people who can help you. Here are some ideas that can help many people.
Share your feelings with someone you are comfortable with.
Spend time with others who have experienced a similar loss.
Give yourself time.
COPING WITH GRIEF AND LOSS – Easy-to-read information 19 Other ideas that may help:
Accept that you are going through a hard time.
Go on doing the things you normally do. But take a break if you need it.
Try not to make big decisions when you are feeling a lot of grief.
Tell someone about any fears or worries you might have. Do things that give you comfort, like visiting the cemetery or a place that holds special memories.
20 COPING WITH GRIEF AND LOSS – Easy-to-read information If there are things you want to say to the person g who has died you can write a letter. You don’t have to send the letter. e You can make a book of any sympathy cards you get.
You can f nd a poem, saying or song that helps you remember the person.
You can look for a comfortable place to relax.
You can put together a e calendar that helps you plan and look forward to coming events.
COPING WITH GRIEF AND LOSS – Easy-to-read information 21 You may keep reminders of the person who has died. You may keep: Photos or a memory book of the things the person liked. A memory box where a favorite thing from the person is kept.
A memory garden where you plant a plant and look after it.
A painting or collage of the person.
A tape of the person’s favorite songs.
22 COPING WITH GRIEF AND LOSS – Easy-to-read information p: k But, remember, what you decide to do will be up to you.
Remember you will probably feel better with time.
If you don’t begin to feel better, ask for help.
COPING WITH GRIEF AND LOSS – Easy-to-read information 23
SUPPORTING PEOPLE WITH DISABILITIES COPING WITH GRIEF AND LOSS
Information for support people
CONTENTS
Easy-to-read information 4 to 23
Information for support people 25 to 36
Introduction 26
T e impact of disability on grieving 28
Cognitive factors 28
Communication factors 30
Learning experiences 30
What to do 31
General strategies to support people with disabilities to deal eff ectively with grief and loss 32
Creative ideas and activities to assist people with disabilities through the grief process 35
Further information 36
References 36
Other Resources 36 Introduction with complex communication needs. However, there is certainly a shift in the way we view Grief is a normal human emotion or set the grief responses of people with disabilities. of emotions that occur in response to a Whereas it was once believed that people with significant loss. It is a universal emotion and disabilities were ‘protected’ from grief, there applies to all human beings regardless of their is now increased acknowledgment that people abilities or disabilities. Grief is our emotional with disabilities also experience grief reactions. response to loss. It can emerge as a result of Tere is a clear and growing awareness that death, bereavement or a multitude of everyday the capacity to grieve is not only based on our experiences related to loss in life. T ese losses ability to understand the concept of grief, but can be actual or perceived. Actual losses can also our ability to feel the loss incurred. In other include the death of a loved one, or the loss of a words, the experience of loss and the subsequent significant relationship in one’s life. A perceived grief can occur, regardless of our understanding loss can include something that was hoped of death. Our approach to supporting people or planned for, that was never realised. T is with disabilities needs to stem from this booklet talks about a range of losses, but mainly notion of ‘experience of loss’ rather than just focuses on feelings of grief and loss as it relates ‘understanding the concept of death’. to the death of someone special for the person. Worden (1991), who has done substantial work Although grief is a universal emotion, the in the area of grief and loss, suggests that grief experience of grief is individual and unique. In consist of four dimensions, namely, feelings, other words, while there are characteristics thoughts, behaviours and physical sensations. of grief and bereavement that are common to most people, each person will experience grief Feelings diff erently. T e life experiences a person has, along with some characteristics sometimes Feelings associated with grief and loss may associated with disability, can have an eff ect include: on how a person grieves, and also how others • Sadness, interpret their grief responses. • Anger, T e literature in this area is very limited, particularly in relation to grief issues for people • Emptiness,
26 COPING WITH GRIEF AND LOSS – Information for support people This booklet has been written with the needs of people with disabilities in mind and includes information and strategies that will be readily accessible to many people.
• Loneliness, • “ I will never get over this”,
• Shock, • “ I feel scared and lonely.”
• Numbness, Behaviours • Confusion, Grief and loss can also be associated with changes • Disbelief, in a persons behaviour and may include:
• Resentment, • Withdrawal,
• Denial, • Physical aggression,
• Frustration, • Verbal aggression,
• Irritability. • Crying,
Thoughts • Changes in eating and toiletting, • Changes in appetite, Changes in a person’s thinking processes may include: • Loss of interest in activities,
• Diffi culty in attending or concentrating, • Sleep disturbance.
• Diffi culty making decisions,
• Concerned and confused thoughts about self and others,
• Pre-occupation with the person who has died.
Additionally, the person may experience particular thoughts that may include:
• “ It can’t be true”,
• “ Why me?”,
• “Am I always going to feel like this”,
COPING WITH GRIEF AND LOSS – Information for support people 27 Physical Sensations can be seen in some people with disability. T ese may relate to cognitive, communication and Grief and loss may also be associated with changes learning experience factors. in body functions including:
• Shortness of breath, Cognitive Factors
• Pounding heart, People with disabilities present with a range of cognitive skills. Where a person has diffi culties • Hypertension, with learning or comprehension, others may draw • Dizziness, assumptions about that person’s ability to deal with loss and grief. T is may lead support people to • Shaking, think that the person with the disability may not • Sweating, have understood what has happened. T ey may also assume that the person does not feel the loss, or that • Pain reactions, they need to be protected from the truth, or that • Tingling and numbness, by not talking about the issue, the loss will be less obvious to them. However, it is important to realise • Fatigue, that people with disabilities don’t need to have a full • Previous illnesses flaring up. understanding of the concept of death to feel the loss. T ey may feel the loss by virtue of the fact that The Impact Of Disability On Grieving an important person in their life is no longer there.
People with disabilities are like everyone else. T ey People can have varying degrees of understanding of may experience a range of losses through their lives, loss, represented in the figure appearing on the next which might set grief reactions. page. As this figure shows, a person’s understanding can range from a ‘sense’ of loss, to a realisation Tere are a number of factors that can impact of the permanency of the loss, to a more abstract on the grieving of the person with a disability. understanding about life and death. But regardless Although we know that grief reactions are very of where a person is on this continuum, the person individual and unique and diff er from one person is likely to feel the loss in some way. to the other, there are some characteristics that
28 COPING WITH GRIEF AND LOSS – Information for support people It is important to realise that people with disabilities don’t need to have a full understanding of the concept of death to feel the loss. They may feel the loss and the grief by virtue of the fact that an important person in their life is no longer there.
Continuum of understanding of loss:
The individual begins to think more abstractly about life and death. w ith
The individual begins to realise the also final and irreversible nature of death. hat s The individual views life ise and death as alternating. full hat re. The individual views death as being a temporary condition. g of ext ing The individual can sense loss and suffer accompanying feelings. ss The individual has difficulty on comprehending death.
COPING WITH GRIEF AND LOSS – Information for support people 29 Communication Factors Learning Experiences
Some people with disabilities have complex T e life experiences of people with disabilities communication needs. T at is, they may can make it diffi cult for them to deal eff ectively be unable to use speech to meet their daily with loss and grief. Parents and staff may treat communication needs. T ey may rely, to varying them diff erently. For example, parents and staff degrees, on augmentative communication at times may try to shield them from the harsh methods, like vocalisations, gestures, and facial realities of life with the fear that they may not be expression. T ey may also rely on alternative able to cope. communication systems. A person with complex People with disabilities might have experienced communication needs may have diffi culty multiple losses over time. T ey may have seen expressing their emotions, asking questions and a number of friends or people they have known conveying information about grief and loss. die. T ey may have also experienced ongoing Some people may show diffi culty expressing staff turnover and changes in residential settings negative emotions because over time they may and living arrangements, many of which are have developed an attitude of trying to please beyond their control. others. T ey may not feel they have the right or If the person has a limited number of close the ‘permission’ to express negative emotions. relationships and social supports, the impact of For some people with disabilities, a change in these losses may be more magnified than would behaviour might be a better indicator of grief otherwise be the case. and loss than what the person communicates If the person who has died is the primary directly through speech or through other means. care giver, then the loss can be experienced at It is also important to be sensitive to any changes multiple levels. As a result of the death, the in eating or sleeping patterns, or interest or person with a disability may not only experience participation in activities and social interactions. the loss of someone they care very much about, T ese may indicate how the person is coping but potentially also experience major changes with the loss. in their daily routine, living arrangements and financial circumstances. Hence, the loss may also trigger anxiety reactions about their own day-to-day living, care and future.
30 COPING WITH GRIEF AND LOSS – Information for support people Because each person and the way they grieve is unique, the kinds of supports and assistance offered will also need to be individualised.
What To Do It is important, where possible, that someone who is close to the person with disability gives Because each person and the way they grieve is the sad news. Tis can help to ease the pain of unique, the kinds of supports and the assistance hearing distressing news. off ered will also need to be individualised. However, there are some general guidelines that T ere is no “good “ way of telling a person about may be helpful to many people with disabilities the death of someone close. Each individual who are experiencing grief. and each situation is unique. People with disabilities will have diff erent experiences in Most importantly, inform the person openly and relation to death and loss. Some may have honestly that death has occurred. T is may seem already experienced the death of someone close a fairly obvious idea, but is often overlooked, and might have dealt with it eff ectively. Others with the person often finding out through here- might have been protected from this concept. say or other indirect channels of communication. T e knowledge you have of the person and If a person is not told about the death openly your relationship with them will very much and honestly, then: determine the manner in which you tell the • T e person’s ‘right to know’ has not been person of the sad news. Some general ideas are: respected. • Tell the person that death has occurred.
• T e person is denied the opportunity to • Explain the death with words that you think learn about life and death. he or she will understand.
• T e person is once again ‘shielded’ from • Allow and encourage expression of feelings. bad news. • Provide reassurance that the person is not • T e person is denied the opportunity to alone and help is available. be part of ‘normal’ grief activities, such as attending the funeral. • Provide company or space as requested.
• T e person may perceive the loss, but not in an accurate way. T ey may comprehend the loss to be something diff erent than what it actually is, and attach an interpretation of death that is much worse than the reality.
COPING WITH GRIEF AND LOSS – Information for support people 31 General strategies to support • Talk about the deceased, ask and allow people with disabilities deal questions. T is gives the person the opportunity to understand that loss has effectively with grief and loss happened, it also reinforces the idea that it Described below are some general strategies that is OK to talk about the death, while also are helpful to consider as you support people giving the listener an opportunity to identify with disabilities to deal with grief and loss. and address any inaccuracies in the person’s T ese strategies may be helpful for many people, understanding of the death. not just those with disabilities. As stated earlier • Accept short conversations. Some people may all people grieve diff erently and their needs for not feel like communicating their thoughts at support will be diff erent. So it is important to the time, or they may not know what to say. remember that these strategies are to be used as However, it is important for the person to guidelines only. know that they can talk about it at some later stage if they feel like it. Encourage open and honest communication • Tolerate silences. Don’t be afraid of silences. Tey are a natural part of the listening • Give explanations appropriate to the person’s process, and can also be useful in terms of level of comprehension. Make sure that giving the person a chance to collect their you use words that the person can easily thoughts. Sometimes, the fact that you are understand. there with the person may be suffi ciently reassuring. • Refrain from abstract explanations. Use clear, simple and concrete phrases. Encourage and allow expression • Use words that describe death in real terms. of emotion For example, “(the person) died” rather than “(the person) passed away”, or “(the person) • Listen, rather than try to ‘fix’. Be aware that has gone to a better place”, or “we’ve lost it is difficult to ‘take the pain away’. T e (the person)”. However, if the person has person will need to work through this process words that describe death in a way that is themselves. T e role of the support person meaningful to them, based on their previous is being there when needed. experiences, then these words can be used.
32 COPING WITH GRIEF AND LOSS – Information for support people Tolerate silences. Don’t be afraid of silences. They are a natural part of the listening process, and can also be useful in terms of giving the person a chance to collect their thoughts.
• Don’t judge. Be aware that we all have our Help the person to understand the own set of values and beliefs. Particularly in reality of the loss relation to grief and loss, people can have a wide range of belief systems, such as varied • Talk about the deceased. It is OK and spiritual beliefs, rituals and other ways of indeed healthy to talk about the person who expressing grief. has died, and this should be encouraged. However, be led by the person who you are • Reassure that it is OK to have a range supporting in this, and do not force this topic of feelings. T is is important in terms of of conversation if the person is not ready normalising diff erent feelings, and also or willing. conflicting types of feelings, such as when someone experiences both deep sadness, but • Encourage the person to participate in the also anger toward the person who has died. rituals (viewing, funeral, visiting gravesite etc.). Taking part in rituals can contribute • Reassure that it is OK to cry. Crying is a to the person’s sense of belonging and normal human response to a significant loss, connectedness, as well as helping the person’s and can be useful as an emotional outlet. own recovery from grief. However, this • Validate the person’s feelings. Let the should always be presented as an option to person know that you can see that they the person, or their advocate. Do not force are experiencing emotional pain, and the person to attend a funeral or participate acknowledge that they are going through a in other rituals if they do not wish to do so. diffi cult experience, but that also, they will • Keep the reminders of the dead person work through this. present. T is is important in terms of • Address fears and anxieties. Listen carefully acknowledging and confronting the loss, but for any specific fears, such as fear that the also as a reminder of the deceased person and person themselves will die, or that their their legacy. Once again, be led by the person, support needs will no longer be met, and because concrete reminders can sometimes be reassure the person appropriately. profoundly painful, particularly in the early stages of grief. In these cases, you may wish to off er these reminders again at a later date.
COPING WITH GRIEF AND LOSS – Information for support people 33 Provide reassurance and support • Encourage the person to use their local support networks. Talking with someone, • Be available, patient and accommodating. such as a friend or family member, who Grief is a complex emotion, and can take time knows the person well and who is familiar to work through. with the person’s circumstances is often the best and most natural type of support. • Provide care, comfort and practical support. A sensitive and flexible approach to support • Additionally, the person may be encouraged will be required. Some times may be more to communicate with others who they may diffi cult than other times, and the person not know so well, but who have been through may require extra support at these moments. a similar loss in their life.
• Encourage routine activities. Routine gives • Support structures that are helpful for people a sense of stability at times of emotional with more complex needs who don’t have a formal communication system may need to turmoil. draw less on strategies based on language • Encourage the person to minimise change. and draw more heavily on environment based When a person has experienced significant strategies. Startegies may need to focus loss, there is usually significant disruption on providing a sense of secutrity, stability, to their life, so it is important to avoid any comfort, routine and continuity for the further and unnecessary changes. person. T ey may also include relaxation supports, such as sensory activities, based on • Discourage the grieving person from making the person’s preferences that are conducive to major decisions. Because of the changes in a calm state and/or expression of emotion. thinking processes associated with grief, • Grief responses can sometimes be associated people can have diffi culty in concentrating on with challenging behaviours, particularly all the relevant factors for making significant when a person’s communication channels are life decisions. If possible, delay big decisions limited and they have diffi culty expressing for a time in the future. their grief in any other way. In this case, • Provide continuity of support in diff erent the involvement of a behavioural support settings. Try to ensure that people are practitioner (e.g., psychologist) may be useful. T is person can explore the underlying supported in their various environments functions of this behaviour and develop and are given consistent messages across these strategies for addressing the challenging environments. behaviour.
34 COPING WITH GRIEF AND LOSS – Information for support people Try to ensure that people are supported in their various environments and are given consistent messages across these environments.
• Off er seeking specialist services, such as photos of the person, a list of favourite things counselling, to people with disabilities who such as foods and places etc. display more complicated grief reactions. • Helping the person create a painting or a People whose grief reactions are of an intense collage or another piece of artwork that or severe nature, take a significant period of represents the deceased person. time and impact on their daily functioning may require specialist and individualised • Assisting the person to write an unsent letter to the deceased if they felt they had things to support to assist them in dealing with say that they couldn’t say at the time, or did their grief. not have an opportunity to say. Creative ideas and activities to • Helping the person make a book of sympathy assist the person with disability cards that were received. through the grief process • Helping the person find a comfortable place to relax if they need some personal quiet time. Contained in this section are some ideas that have been found to be useful when assisting • Making a tape of the deceased person’s favourite songs. people with disabilities to deal with grief and loss. As stated earlier each person’s way of • Helping the person to find a poem, saying dealing with grief is unique and individual or a song that helps them remember the and so are their support needs. So it is very deceased person, but that also brings a sense important that support people consider these of comfort. ideas in the light of their knowledge of the • Assisting the person to explore a new leisure person and what that person may wish. Once activity. you feel the person is ready, some possibilities to consider and off er are: • Assisting the person to develop and use a calender as a way of planning and looking • Creating a memory box where a favourite forward to coming events. item or a few items of the deceased is kept . • Some of these ideas also appear in • Creating a memory garden where a plant is Luchterhand and Murphy (1998), which is planted and looked after. a recommended resource in this area. • Creating a memory workbook where the person can choose to include things like
COPING WITH GRIEF AND LOSS – Information for support people 35 Further information Other Resources
In this booklet, we have presented information Luchterhand, C. (l998). Mental retardation and for people with disabilities and support people grief following a death loss: Information for about grief and loss. While many people who families and other caregivers. Arlington, TX: have experienced a loss will be supported T e Arc. eff ectively by their local support, some may Hollins, S. (1995). Managing grief better: People require additional support to deal with their with developmental disabilities. Habilitative grief, such as people experiencing complex or Mental Healthcare Newsletter 14/3. Available prolonged grief reactions. In this case, contact at: http://www.thearc.org/faqs/grief.html. with a local service provider experienced in working in this field is recommended. Watchman, K. (2000). Let’s talk about death : a booklet about death and funerals for adults References who have a learning disability. Edinburgh, UK: Scottish Down’s Syndrome Association. Worden, J. W. (1991). Grief Counselling and grief therapy: A handbook for the mental health practitioner (2nd ed.). London: Springer.
Luchterhand, C., & Murphy, N. (1998). Helping adults with mental retardation grieve a death loss. Philadelphia: Taylor & Francis.
36 COPING WITH GRIEF AND LOSS – Information for support people T is publication is linked to the work of the Bridging Project. T e Bridging Project is being undertaken by Scope in collaboration with the Centre for Developmental Disability Health Victoria, Monash University. T e mission of the Bridging Project is to progress the knowledge and resource base to ensure that people with complex communication and mental health needs have access to quality services. T e project has two complimentary streams, Building Evidence (increasing the evidence base in relation to individuals with complex communication and mental health needs through research and related activities) and Building Capacity (building the capacity of services to address the mental health needs and preferences of individuals with complex communication needs). T e project is designed around the needs of people who are 18 years or older. More information regarding T e Bridging Project can be found at the Scope Web Page, http://www.scopevic.org.au 830 Whitehorse Road Box Hill, Victoria 3128 Ph: (03) 9843 3000 Fax: (03) 9843 2030 www.scopevic.org.au FACT SHEET
Incident notifcation The Work Health and Safety Act 2011 (WHS Act) requires the regulator to be notifed of certain ‘notifable incidents’. This fact sheet will help you decide whether the regulator needs to be notifed of a work-related injury, illness or dangerous incident under the act. Work health and safety regulators are committed to preventing work-related deaths and injuries. Notifying the regulator of ‘notifable incidents’ can help identify causes of incidents and prevent similar incidents at both that workplace and other workplaces. The Work Health and Safety Act 2011 Part 3 of the WHS Act requires the regulator to be notifed of serious workplace incidents and for the site of these incidents to be preserved until an inspector arrives or directs otherwise (subject to some exceptions). In summary part 3 of the WHS Act requires: • immediate notifcation of a ‘notifable incident’ to the regulator after becoming aware of it • if the regulator asks – written notifcation within 48 hours of the request • preservation of the incident site until an inspector arrives or directs otherwise. Failing to notify is a criminal offence and penalties apply.
What is a ‘notifable incident’ A ‘notifable incident’ as outlined in the WHS Act is: • the death of a person • a ‘serious injury or illness’, or • a ‘dangerous incident’ arising out of work carried out by a business or undertaking or a workplace. ‘Notifable incidents’ may relate to any person – whether an employee, contractor or member of the public. Only the most serious safety incidents are intended to be notifable, and they trigger requirements to preserve the incident site pending further direction from the regulator – see page 2.
Serious injury or illness Notifcation is required of a serious injury or illness of a person if they require any of the following. Note: even if immediate treatment is not readily available, for example because the incident site is rural or remote or because the relevant specialist treatment is not available, the notifcation must still be made.
June 2012 Trigger Example
Immediate treatment as an in-patient in a hospital Admission into a hospital as an in-patient for any duration, even if the stay is not overnight or longer. It does not include: • Out-patient treatment provided by the emergency section of a hospital (ie not requiring admission as an in-patient) and immediate discharge. • Subsequent corrective surgery such as that required to fx a fractured nose.
Immediate treatment for the amputation of any Amputation of a limb such as arm or leg, body part such as hand, foot or the part of the body tip of a fnger, toe, nose or ear. It does not include: Bruising or minor abrasion or laceration to the skin. Immediate treatment for a serious head injury • Fractured skull, loss of consciousness, blood clot or bleeding in the brain, damage to the skull to the extent that it is likely to affect organ/ face function. • Head injuries resulting in temporary or permanent amnesia. Immediate treatment for a serious eye injury • Injury that results in or is likely to result in the loss of the eye or total or partial loss of vision. • Injury that involves an object penetrating the eye (for example metal fragment, wood chip). • Exposure of the eye to a substance which poses a risk of serious eye damage. It does not include: Eye exposure to a substance that merely causes irritation.
Immediate treatment for a serious burn A burn requiring intensive care or critical care which could require compression garment or a skin graft. It does not include: A burn that merely requires washing the wound and applying a dressing.
Immediate treatment for the separation of skin Separation of skin from an underlying tissue such that tendon, bone or from an underlying tissue (such as degloving or muscles are exposed (de-gloving or scalping). scalping)
Immediate treatment for a spinal injury Injury to the cervical, thoracic, lumbar or sacral vertebrae including the discs and spinal cord.
Immediate treatment for the loss of a bodily Loss of consciousness, loss of movement of a limb or loss of the sense of function smell, taste, sight or hearing, or loss of function of an internal organ. It does not include: • mere fainting, or • a sprain, strain or fracture. Immediate treatment for serious lacerations • Serious lacerations that cause muscle, tendon, nerve or blood vessel damage or permanent impairment. • Deep or extensive cuts. • Tears of wounds to the fesh or tissues – this may include stitching to prevent loss of blood and/or other treatment to prevent loss of bodily function and/or infection.
Medical treatment within 48 hours of exposure to a substance
2 Trigger Example
Any infection to which the carrying out of work is a signifcant contributing factor, including any infection that is reliably attributable to carrying out work: • with micro-organisms • that involves providing treatment or care to a person • that involves contact with human blood or body substances • that involves handling or contact with animals, animal hides, skins, wool or hair, animal carcasses or animal waste products.
The following occupational zoonoses contracted in the course of work involving handling or contact with animals, animal hides, skins, wool or hair, animal carcasses or animal waste products: • Q fever • Anthrax • Leptospirosis • Brucellosis • Hendra Virus • Avian Infuenza • Psittacosis.
Treatment ‘Treatment’ means the kind of treatment that would be required for a serious injury or illness and includes ‘medical treatment’ (ie by a registered medical practitioner), treatment by a paramedic or treatment by a registered nurse.
Dangerous Incidents (commonly referred to as ‘near misses’) Notifcation is also required of any incident in relation to a workplace that exposes a worker or any other person to a serious risk to a person’s health or safety emanating from an immediate or imminent exposure to: • an uncontrolled escape, spillage or leakage of a substance • an uncontrolled implosion, explosion or fre • an uncontrolled escape of gas or steam • an uncontrolled escape of a pressurised substance • electric shock: examples of electrical shock that are not notifable
■ shock due to static electricity
■ ‘extra low voltage’ shock (ie arising from electrical equipment less than or equal to 50V AC and less than or equal to 120V DC)
■ when defbrillators are used deliberately to shock a person for frst aid or medical reasons examples of electrical shocks that are notifable
■ minor shock resulting from direct contact with exposed live electrical parts (other than ‘extra low voltage’) including shock from capacitive discharge • the fall or release from a height of any plant, substance or thing • the collapse, overturning, failure or malfunction of, or damage to, any plant that is required to be design or item registered under the work health and safety regulations • the collapse or partial collapse of a structure • the collapse or failure of an excavation or of any shoring supporting an excavation
3 • the inrush of water, mud or gas in workings, in an underground excavation or tunnel, or • the interruption of the main system of ventilation in an underground excavation or tunnel. Any of these occurrences are reportable as a ‘dangerous incident’ (or ‘near miss’) if a person is exposed to a serious risk from immediate or imminent exposure to a hazard. For most hazards such as plant or a structure collapsing a person will need to be in the immediate vicinity to be exposed to a serious risk to their health or safety. However some hazards such as an uncontrolled leak of a hazardous gas or a fre can travel towards a person and expose them to a serious risk to health and safety away from the original source. A dangerous incident includes both immediate serious risks to health or safety, and also a risk from an immediate exposure to a substance which is likely to create a serious risk to health or safety in the future, for example asbestos or chemicals. Only occurrences involving a ‘serious risk’ are notifable taking into account the likelihood of a serious illness or injury occurring from the incident. This would include any situation which seriously endangers or threatens the health or safety of a person.
Only work-related incidents are notifable Sometimes incidents occur at a workplace (or in the vicinity of a workplace) that do not arise out of work, or the way work is carried out or the workplace itself. These kinds of incidents that are unrelated to work or a workplace are not notifable. For example: • a worker or another person suffers a heart attack while at work which is unrelated to work or the workplace • an amateur athlete is injured while playing for the local soccer team and requires immediate medical treatment (this is not work) • a person driving to work is injured in a car accident (where driving is not part of their work) • a person with a known history of epilepsy has a seizure at work. Work-related incidents that occur outside a workplace may be notifable Work-related incidents may occur outside the workplace and these may still be notifable if they involve a death, serious illness or injury or a dangerous incident. For example: • an object like a hand tool is kicked off a multi-storey building under construction hitting a person below • scaffold collapse that causes serious injury to persons below • cladding is dislodged off a multi-storey building that is a workplace, hitting a person passing by at street level. Who is responsible for notifying Any person conducting a business or undertaking (PCBU) from which the ‘notifable incident’ arises must notify the regulator immediately after becoming aware that it has occurred. A PCBU is a term that encompasses types of modern working arrangements. It can include corporations, partnerships, unincorporated or incorporated associations, the self employed, sole traders or the Crown. For more information on the defnition of a PCBU see the Interpretive guidelines: the meaning of ‘person conducting a business or undertaking’.
Incidents involving multiple businesses or undertakings If the ‘notifable incident’ arises out of more than one business or undertaking then each must ensure that the incident has been notifed to the regulator. In these circumstances the duty holders must, so far as is reasonably practicable, consult, cooperate and coordinate to put appropriate reporting and notifcation arrangements in place. For example contractors at a construction workplace may agree that the principal contractor for the workplace will notify of all ‘notifable incidents’ that occur at the workplace.
4 Incidents involving a ‘state-based contractor working for a Commonwealth entity’ Workplaces shared by a Commonwealth entity and one or more state-based contractors may be covered by both Commonwealth and state or territory work health and safety laws. For example an asbestos removal company is engaged by the Department of Defence (Defence) to carry out asbestos removal work at Randwick Army Barracks in Sydney and a dangerous incident occurs (as defned above). Because the incident has occurred at a place where work is carried out for Defence (on behalf of the Commonwealth) the company must ensure that both Comcare and WorkCover are notifed of the incident. Defence and the company may co-operate so that only one notifcation is made to Comcare and WorkCover NSW on behalf of both.
When and how to notify A regulator must be notifed of a ‘notifable incident’ immediately after the PCBU becomes aware of the incident arising from the business or undertaking. See page 7 for contact details. The notice must be given by the fastest possible means. In NSW this is by telephone on 13 10 50. For after-hours notifcations the 13 10 50 number will provide options for you to be diverted to WorkCover’s After Hours Emergency Service. When notifcations are made by telephone follow-up information may be requested either by telephone or in writing. If you are asked to follow-up in writing you must provide the required information in writing within 48 hours of the request being made. Regulators have adopted a commonsense approach to assessing whether an incident has been notifed immediately. In other words incidents must be notifed immediately as the particular circumstances permit. In general a PCBU ‘becomes aware’ of a notifable incident at the time that any of their workers in supervisory or managerial roles become aware of that incident. For example if a worker suffers a serious injury and notifes their immediate supervisor it is at this point that the PCBU is considered to be aware of the incident. PCBUs should put into place internal notifcation procedures to ensure compliance with their notifcation obligations. It is essential that PCBUs develop appropriate internal communication systems to ensure safety incidents are promptly brought to the relevant persons’ attention.
Information that will be requested A clear description of the incident with as much detail as possible will help the regulator assess whether or not the incident is notifable and the need for a follow-up investigation by the regulator. Where insuffcient details are provided in a telephone notifcation, the regulator may contact the notifer if further information is required. All work health and safety regulators have agreed that the following (see table below) information should be collected as a minimum at the point of incident notifcation.
What happened: an overview • Provide an overview of what happened. • Nominate the type of notifable incident – was it death, serious injury or illness, or ‘dangerous incident’ (as defned above)?
When did it happen Date and time.
Where did it happen Incident address. Details that describe the specifc location of the notifable incident – for example section of the warehouse or the particular piece of equipment that the incident involved – to assist instructions about site disturbance.
What happened: Detailed description of the notifable incident. detailed description Who did it happen to • Injured person’s name, salutation, date of birth, address and contact number. • Injured person’s occupation. • Relationship of the injured person to the entity notifying.
5 How and where are they • Description of serious injury or illness – ie nature of injury. being treated (if applicable) • Initial treatment of serious injury or illness. • Where the patient has been taken for treatment.
Who is the person conducting • Legal and trading name. the business or undertaking • Business address (if different from incident address), ABN/ACN and contact details (there may be more than one) including phone number and email.
What has/is being done Action taken or intended to be taken to prevent recurrence (if any). Who is notifying • Notifer’s name, salutation, contact phone number and position at workplace. • Name, phone number and position of person to contact for further information (if different from above) Although all of this information may not be available at the time of notifcation, PCBUs must still notify the regulator immediately of the incident and provide the information they have. The rest of the information will be collected by the regulator at a later time.
Site preservation The person with management or control of a workplace at which a notifable incident has occurred must ensure, so far as is reasonably practicable, that the site where the incident occurred is not disturbed until an inspector arrives at the site or directs otherwise (whichever is earlier). Requirements to preserve the incident site apply to any plant, substance, structure or thing associated with the notifable incident. This means that any evidence that may assist an inspector to determine the cause of the incident is preserved. An incident site may be disturbed: • to assist an injured person • to remove a deceased person • to make the site safe or to minimise the risk of a further notifable incident • to facilitate a police investigation, or • after an inspector has given a direction to do so either in person or by telephone. The sooner the regulator is notifed, the sooner the site can be released. If, however, after arriving at the incident site an inspector considers that it should remain undisturbed in order to facilitate investigation of the incident they may issue a non-disturbance notice. This notice must specify the period for which the notice is to apply – no more than seven days. Penalties apply if an individual or body corporate fails to preserve a site.
Site preservation requirements only apply to the incident site Requirements to preserve a site only apply in relation to the immediate area where the incident occurred – not the whole workplace.
Directions on site preservation If you are unsure about what you need to do to preserve a site, ask the regulator when you notify them of the incident. You can also ask the regulator to be relieved of your legal obligations to preserve the incident site at this point – even if you don’t meet the strict criteria above.
Upgrading notifcations If a notifable incident escalates from a serious illness or injury to a death the regulator must be separately notifed of the death immediately after becoming aware that the person has died.
Record keeping requirements The notifer must keep a record of the notifable incident for at least fve years from the date of notifcation. Penalties apply for failing to do so.
6 As a practical matter these records should include any directions or authorisations given by an inspector at the time of notifcation (including authorisations to disturb incident sites) and any confrmation you received from the regulator that you notifed them about the incident.
Contact details for regulators To notify a ‘notifable incident’ contact the regulator in the relevant jurisdiction (see table below).
Jurisdiction Regulator Telephone Website
New South Wales WorkCover NSW 13 10 50 Not applicable for notifcations
Victoria WorkSafe Victoria 1800 136 089 worksafe.vic.gov.au
Queensland Workplace Health and Safety Qld 1300 369 915 worksafe.qld.gov.au
South Australia SafeWork SA 1300 365 255 safework.sa.gov.au
Western Australia WorkSafe WA 1300 307 877 worksafe.wa.gov.au
Australian Capital WorkSafe ACT (02) 6207 3000 worksafety.act.gov.au Territory
Tasmania Workplace Standards Tasmania 1300 366 322 (Tas) wst.tas.gov.au (03) 6233 7657 (External)
Northern Territory NT WorkSafe 1800 019 115 worksafe.nt.gov.au
Commonwealth Comcare 1300 366 979 comcare.gov.au
Further information For further information on notifable incidents including the relevant laws please contact your work health and safety regulator.
Disclaimer This publication may contain work health and safety and workers compensation information. It may include some of your obligations under the various legislations that WorkCover NSW administers. To ensure you comply with your legal obligations you must refer to the appropriate legislation. Information on the latest laws can be checked by visiting the NSW legislation website (www.legislation.nsw.gov.au). This publication does not represent a comprehensive statement of the law as it applies to particular problems or to individuals or as a substitute for legal advice. You should seek independent legal advice if you need assistance on the application of the law to your situation. ©WorkCover NSW
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