Behaviour Support Plans (BSP) for Residential Aged Care

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Published: 20 September 2021

As of 1 September 2021, it is now a requirement for residential aged care providers to have behaviour support plans (BSPs) in place for certain residents (DoH 2021).

This new requirement is an update to the Quality of Care Principles 2014, in accordance with the Aged Care and Other Legislative Amendment (Royal Commission Response No.1) Act 2021 (Cth) (Manganaro 2021).

What is Behaviour Support?

Sometimes, aged care residents will display behaviours that indicate they require extra support. These are known as changed behaviours. Often, changed behaviours are a signal that the resident is experiencing stress, wants to communicate something or has an unmet need (DSA 2021a).

Note: Changed behaviours are sometimes referred to as ‘behaviours of concern’ or ‘challenging behaviours'. However, the term 'changed behaviours' is preferred as it avoids negatively stigmatising people who display behaviours that indicate a need for support (DSA 2021).

Some reasons why changed behaviours might occur include:

  • Pain, discomfort or illness
  • Interruption to routine
  • Fatigue
  • Medication changes, side effects or interactions
  • Changes to the living environment
  • Life events
  • Wanting to communicate something
  • Boredom or loneliness
  • Delirium
  • Constipation
  • Dehydration
  • Hunger or low blood sugar
  • Mental illness (e.g. depression or anxiety)
  • Hallucinations or delusions
  • Drug, alcohol or smoking withdrawal
  • Terminal restlessness
  • Sensory impairment.

(Carer Gateway 2021; VIC DoH 2019)

Behaviour support involves developing processes and strategies to proactively respond to and care for residents who are displaying changed behaviours, and avoiding anything that might negatively affect these behaviours (DSA 2021a).

What is a Behaviour Support Plan (BSP)?

worker and client discussing behaviour support plan

A behaviour support plan (BSP) is used to assist in the care and support of a resident who displays changed behaviours (DoH 2021).

It forms part of a resident’s existing care and services plan and is required for any resident who:

  • Requires behaviour support for changed behaviours
  • Has been assessed as requiring the use of a restrictive practice, or
  • Is currently experiencing a restrictive practice.

(DoH 2021)

A BSP must:

  • Contain best-practice support strategies for the resident
  • Be responsive to the resident’s needs
  • Aim to minimise the need for restrictive practices
  • Provide individualised supports
  • Address any underlying issues of concern
  • Provide safeguards
  • Aim to optimise the resident’s health and wellbeing.

(DoH 2021)

The Behaviour Support Process

Dementia Support Australia lists five steps of the behaviour support process:

  1. Identify
  2. Assess
  3. Plan
  4. Implement
  5. Evaluate.

1. Identifying Changed Behaviours

The first step is to recognise behaviours that indicate a resident might require additional support.

Examples of changed behaviours include:

  • Verbal disruptions
  • Sleep disturbances
  • Inappropriate sexual behaviours
  • Physical aggression
  • Refusal to accept help or services
  • Wandering or intrusiveness
  • Inappropriate social behaviours
  • Issues related to eating
  • Resistance to personal care
  • Repetitive actions or questions.

(DSA 2021a, b)

Upon noticing these behaviours, your immediate priority should be to take appropriate action to ensure the safety of the resident and others. If the resident has an existing care plan in place, this should be implemented (DSA 2021a).

Once the situation has been resolved, the changed behaviour should be appropriately reported (DSA 2021a).

2. Assessing the Behaviour

This step involves using the ABC Approach to Behaviour Management in order to gain a greater understanding of why the resident is behaving in this way and identify any underlying causes (DSA 2021a).

For more information on the ABC approach, see the Article: Behaviour Management and BPSD.

During this step, you might need to consider different aspects of the resident’s life, including:

  • Physical health
  • Cognitive health
  • Personality
  • Whether they are experiencing sensory issues
  • Life history and what matters to them
  • Mental health
  • Environmental factors
  • Relationships
  • Communication skills and abilities
  • Routine
  • Engagement or lack of engagement.

(DSA 2021a)

3. Developing a Behaviour Support Plan

The next step is to develop a BSP in consultation with the resident. This should be individualised and tailored to the resident’s preferences and needs (DSA 2021b).

A BSP may include interventions such as engagement strategies, communication strategies or environmental strategies (DSA 2021b).

What Should a Behaviour Support Plan Contain?

Note: For a more comprehensive explanation of what needs to be included in a BSP, see the Quality of Care Principles 2014.

According to the Quality of Care Principles, a BSP must set out the following:

Alternative strategies for addressing changed behaviours:
  • Information about the resident’s background and past experiences that may help the provider to better understand the resident’s behaviour
  • Assessments of the resident that may help the provider to better understand the resident’s behaviour
  • Changed behaviours that the resident may require support for
  • Information about each occurrence of changed behaviour where the resident required support, including:
    • The date, time and duration of the changed behaviour Any negative consequences experienced by the resident or other people
    • Any related incidents
    • Any warning signs, triggers or causes of the changed behaviour (e.g. trauma, injury, illness or unmet needs)
  • Alternative strategies for addressing these changed behaviours that:
    • Are best-practice
    • Take the resident’s preferences and matters of interest into consideration
    • Aim to optimise the resident’s quality of life and engagement
  • Alternative strategies that have been considered for use, or have been used
  • For any alternative strategies that have been used:
    • How effective these strategies were in addressing the changed behaviour
    • Records of the monitoring and evaluation of the strategies
  • A description of the provider’s consultation about the use of alternative strategies, either with the resident or the resident’s representative
If the use of a restrictive practice has been assessed as necessary:
  • The resident’s changed behaviours requiring the use of a restrictive practice
  • The restrictive practice to be used, including its intended duration, frequency and outcome, and how to use it
  • Best-practice alternative strategies that must be considered before using the restrictive practice
  • The way in which the use of the restrictive practice will be monitored and reviewed
  • A description of the provider’s consultation about the use of the restrictive practice, either with the resident or a substitute decision‑maker (if the resident cannot give consent)
  • A record of informed consent from the resident or a substitute decision‑maker.
If a restrictive practice has been used:
  • The restrictive practice and how it was used, including:
    • When it began to be used
    • The duration of each use
    • How often it is used
    • The outcome of the use, and whether the intended outcome was achieved
  • If the restrictive practice is being used on an as‑needed basis:
    • The changed behaviour that led to the restrictive practice being used
    • Any actions that were taken prior to using the restrictive practice (e.g. alternative strategies)
  • The details of the people involved in the use of the restrictive practice
  • The details of engagement with external support services in relation to the use of the restrictive practice
  • Details of the monitoring and review of the use of the restrictive practice as required by the BSP
If the ongoing use of a restrictive practice is required:
  • The restrictive practice to be used, including its intended duration, frequency and outcome, and how to use it
  • How the ongoing use of the restrictive practice will be monitored and reviewed
  • A description of the provider’s consultation about the use of the restrictive practice, either with the resident or a substitute decision‑maker (if the resident cannot give consent)
  • A record of informed consent from the resident or a substitute decision‑maker

4. Implementing the Behaviour Support Plan

Once the BSP has been developed, these strategies should be implemented. Each person involved in the resident’s care must understand their new responsibilities and be able to confidently deliver the resident’s support strategies (DSA 2021b).

Being able to consistently implement support strategies is crucial (DSA 2021b).

5. Evaluating the Behaviour Support Plan

The BSP is expected to be regularly reviewed and revised in order to assess the effectiveness of support strategies and ensure the resident is being supported in a way that best meets their care needs (DSA 2021b).

Additional Resources


References

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