Version / 3
Author: / Ms. Eithne Ni DhomhnaillNursing Matters and Associates.
Issue Date: / January 2016
Review date: / January 2017.
Authorised by:
1.0Policy Statement
It is the policy ofthe centre that robust systems will be in place to safeguard our residents from abuse and to ensurethat suspicions and allegations of abuse to residents will be managed in accordance with best practice and in a manner that puts the welfare, protection and needs of the resident central to all decision making.
2.0Purpose of the policy
2.1To outline the systems in place to safeguard residents from abuse.
2.2To outline the procedure to be followed in response to an allegation, suspected or actual off abuse of a resident in the home.
3.0Objectives
3.1To outline the procedures that must be followed where suspicions and / or allegations of abuse are made.
3.2To promote an environment in which residents and those concerned about potential abuse can disclose their concerns and receive the appropriate response.
3.3To ensure that all staff are aware of the standards of care that are expected from them in relation to the protection of the safety and welfare of residents.
3.4To ensure that staff are protected from situations that may render them vulnerable to allegations of abuse.
4.0Scope of this policy
This policy applies to all staff employed in or contracted to provide services to the centre.
5.0Definitions.
5.1Vulnerable Adult: an adult who is restricted in capacity to guard himself/herself against harm orexploitation or to report such harm or exploitation. This may arise as a result of physical orintellectual impairment and risk of abuse may be influenced by both context and individual circumstances (HSE, 2014).
5.2Elder Abuse: ‘A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights.’
(Action on Elder Abuse, 1995).
5.3Categories of Elder Abuse (NCAOP, 2002)
5.3.1Physical Abuse: The infliction of pain or injury, physical coercion, physical/chemical restraint.
5.3.2Psychological/Emotional Abuse: The infliction of mental anguish. This is usually characterised by a pattern of behaviour repeated over time and intended to maintain a hold of fear over the older person.
5.3.3Financial Abuse: The illegal or improper exploitation and/or use of finances or resources/property belonging to the older person.
5.3.4Sexual Abuse: Non-consensual sexual contact of any kind with an older person
5.3.5Neglect and acts of omission: Failure to provide appropriate physical, social and healthcare needs, including withholding life necessities such as medication, nutrition and heat.
5.3.6Discriminatory Abuse: Racism, Sexism and other forms of intimidation or harassment.
5.3.7Institutional abuse: may occur within residential care and acute settings including nursing homes, acute hospitals and any other in‐patient settings, and may involve poor standards of care, rigid routines and inadequate responses to complex needs (HSE, 2014).
5.4Intimate care has been defined as ‘care tasks associated with bodily functions, body products and personal hygiene which demand direct or indirect contact with or exposure of the sexual parts of the body”(Cambridge and Carnaby, 2000 cited in HIQA, 2013) It may include the following:
■Help with eating
■Oral care (brushing teeth)
■Shaving
■Skin care or applying external medication
■Hair care
■Dressing and undressing (underwear and clothing)
■Helping someone to use the toilet
■Changing soiled continence pads
■Bathing or showering
■Washing intimate parts of the body i.e. genitalia
■Administering enemas
■Administering rectal medication
■Catheter or stoma care
(Cambridge and Carnaby, 2000 cited in HIQA, 2013).
The possibility of abuse should be considered if a vulnerable person (resident) appears to have suffered a suspicious injury for which no reasonable explanation can be offered. It should also be considered if the vulnerable person seems distressed without obvious reason or displays persistent or new behavioural difficulties. The possibility of abuse should also be considered if the vulnerable person displays unusual or fearful responses to carers. A pattern of ongoing neglect should also be considered even when there are short periods of improvement. Financial abuse can be manifested in a number of ways, for example, in unexplained shortages of money or unusual financial behaviour (HSE, 2014)
6.0Responsibilities(Adapt as appropriate to the local management and staffing structures).
6.1Registered Provider.
The registered provider for the centre is(Specify).He/shehas overall responsibility to ensure that systems, policies and procedures are in place to safeguard residents from abuse. This includes ensuring that resources are available to safeguard residents in the centre.
6.2Person in Charge
The person in charge is responsible for the operational management of systems for safeguarding in the centre, which includes the following:
6.2.1Ensuring that relevant policies, in particular those referred to in this policy are in place and disseminated within the home.
6.2.2Ensuring that staff have read and understood the policies referred to including this policy and have signed to that effect.
6.2.3Ensuring that staff have the relevant knowledge and competency to safeguard residents through information and training, both on induction and through updates at least every two years.
6.2.4Ensuring that the implementation of this policy is monitored as part of the clinical governance and quality monitoring in the home.
6.2.5Ensuring that residents are aware of their rights, including how to make a complaint or report abuse.
6.2.6Ensuring that residents have information about and access to advocacy services both on an in house and independent level.
6.2.7Ensuring that all statutory notifications relating to allegations of abuse are submitted within the time frames stipulated.
6.2.8Ensuring that the outcomes of investigations are used as appropriate to improve practices in the home, including appropriate dissemination of learning to staff, with regard to any requirements for confidentiality.
6.2.9Ensuring that records are maintained of all staff that have signed that they have read and understood the policy.
6.2.10Ensuring that recruitment records are filed and maintained for all new staff in accordance with the centre’s recruitment procedures, including staff vetting.
6.2.11Ensuring that all new staff have received instruction on safeguarding residents and responding to allegations of abuse.
6.2.12Ensuring that all staff attend updates on safeguarding and elder abuse at least every three years and as required by changes to practice, audits or findings of investigations related to allegations/incidents of abuse. (Neither the national regulations or standards here or the UK identify the frequency at which training should be carried out, however in Northern Ireland, the RQIA (2011) states ‘It is recommended that update training takes place at least every three years, unless otherwise stipulated in the Minimum Standards relevant to your service area’).
6.3Nurse Managers.
Nurse Managers in the centre have the following responsibilities related to the safeguarding of residents and responding to allegations or suspicions of abuse:
6.3.1Maintenance of personal competency in relation to safeguarding residents.
6.3.2Monitoring and supervising staff in the care of residents to ensure that care and services are delivered in accordance with the nursing home’s policies and procedures.
6.3.3Identifying any knowledge or competency deficits among staff and liaising with the person in charge to address these.
6.4Person Deputising for Person in Charge in his/her absence(Specify who this person is eg. this may be an ADON/ CNM or other named nurse).
The (specify) has the following responsibilities:
6.4.1In the absence of the person in charge ensuring,ensuring that all statutory notifications relating to allegations of abuse are submitted within the time frames stipulated.
6.4.2In the absence of the person in charge, co-ordinating the response to allegations of abuse according to the procedures outlined in this policy.
6.4.3Assisting in investigations and action planning as directed by the person in charge.
6.4.4Reporting allegations of abuse made against the person in charge to the senior case worker/safeguarding team and assisting in investigations as directed by the team.
6.5Registered Nurses.
Registered nurses have the following specific responsibilities for implementation of this policy:
6.5.1Completion of person centred assessments and care plans with residents as far as each resident is able and seeking the views and observations of the resident’s representative to inform care planning as required.
6.5.2Ensuring that residents are given sufficient information in an appropriate format when making decisions about their care.
6.5.3Ensuring that they comply with national policy and legislation on consent when carrying out assessment, care planning and the provision of care.
6.5.4Providing direction and support to healthcare assistants in safeguarding residents.
6.5.5Supervising the activities of healthcare assistants to monitor adherence to policies and procedures of the home.
6.5.6Responding to allegations of abuse, whether actual or suspected in accordance with this policy.
6.5.7Promotion of residents’ rights, dignity and privacy in accordance with the policies and procedure of the home.
6.6Healthcare assistants.
Healthcare assistants have the following specific responsibilities for implementation of this policy:
6.1.1Providing care and services to residents under the direction of registered nurses and in accordance with the resident’s known wishes and preferences.
6.1.2Ensuring that they seek and obtain the resident’s permission prior to undertaking and care activity.
6.1.3Reporting any concerns about any risk of abuse to residents to the clinical nurse manager or person in charge.
6.1.4Responding to allegations or suspicions of abuse in accordance with this policy.
6.1.5Promotion of residents’ rights, dignity and privacy in accordance with the policies and procedure of the home.
6.2All staff employed by the centre.
6.2.1All staff employed by the centre should be aware that safeguarding residents is an essential part of their duty. Staff must be alert to the fact that abuse can occur in a range of settings and therefore must make themselves aware of the signs of abuse and the appropriate procedures to report such concerns or allegations of abuse.
6.2.2All staff must attend training on safeguarding and elder abuse on induction and at least every three years.
6.2.3All staff must comply with the policies and procedures of the home.
6.2.4Staff must treat all residents with dignity and respect as outlined in the relevant policies of the home.
6.2.5All staff have a responsibility to report any suspicions or information about the abuse of a resident in accordance with the procedures outlined in this policy.
6.2.6All staff must inform their line manager if they have any concerns about their knowledge or competency related to safeguarding residents and responding to allegations or suspicions of abuse.
6.2.7Any staff member who has any concerns about the care and services to residents in the home has a responsibility to raise these under the protected disclosure policy.
6.2.8All healthcare professionals have a responsibility to advocate for residents who are unable to advocate for themselves.
7.0Quick Reference Guide to Responding to Suspicions/ Allegations of Elder Abuse
Where the Person in charge is not on duty, he must be informed at the earliest opportunity.
8.0Organisational Arrangements for Safeguarding Residents in The Centre.
8.1The centreacknowledges the rights of residents to lead as normal a life as possible in the home and adopts a range of measures in order to protect the rights of residents and safeguard residents from any form of abuse. These include:
8.1.1The nursing home operates a strict recruitment and selection process for prospective employees and work experience students, which is aimed at ensuring that staff are suitable to care for vulnerable residents. This includes the need for Garda vetting and satisfactory references to be furnished to (specify).
8.1.2All employees receiveinstruction on the prevention and response to allegations of elder abuse on induction and at least on a two yearly basis.
8.1.3Elder Abuse training is evaluated to ensure that staff have the knowledge to safeguard residents and to respond appropriately to suspicions, allegations or witnessed episodes of abuse.
8.1.4Each resident has a person centred assessment on admission to the home and a care plan is developed with the resident as far as each resident is able and / or with their representative as appropriate to ensure that the care plan is based on the resident’s needs, known wishes and preferences.
8.1.5The nursing home includes choice in care and every day activities and encourages residents to make informed decisions about the care and daily routines. This is facilitated through the assessment and care planning system; activities programme and menu planning in the Centre.
8.1.6While recognizing the duty to carry out risk assessments and put measures in place to manage risks, the nursing home has a positive risk taking approach to decision making about risks to individual residents that recognizes residents’ right to risk.
8.1.7The nursing home has a protected disclosure policy and procedures which provide a confidential and safe mechanism for staff to raise concerns about the care and welfare of residents.
8.1.8The nursing home ensures that residents have access to advocacy mechanisms and services through the facilitation of a residents’ committee and access to independent advocacy services.
8.1.9The nursing home is proactive in ensuring that no resident is socially isolated and actively promotes the continuation of relationships and community links for residents through its open visiting policy and activity programme, which includes activities that foster links with the local community.
8.1.10The nursing home encourages and facilitates residents to manage their own finances, and operates a transparent system for all financial transactions between the resident and the centre.
8.1.11Each resident has access to lockable storage space to store personal belongings.
8.1.12The centre has policies and procedures on the following areas so as to provide direction and guidance to staff on safeguarding and protecting residents’ rights and dignity in care and delivery of services.
■Privacy and Dignity.
■Meeting Communication Needs.
■Management of residents’ property and valuables.
■Information Governance.
■Consent and Advocacy.
■Provision of Information to Residents.
■Complaints.
■Provision of Intimate Care.
■Use of restraint, physical, chemical and environmental.
■Assessment and care planning.
■Positive risk taking.
■Caring for residents with reactive, responsive behaviours.
9.0Immediate Response(Within 24hours) to Allegations or suspicions of Abuse of a Resident
9.1The following procedure must be followed where a person (where person refers to a staff member, a volunteer, or a professional contracted to provide services to residents):
Receives information that any of the residents inthe centreare at risk of being abused.
Receives an allegation that a resident has been abused.
Suspects that a resident has been abused because of the presence of abuse indicators.
Witnesses an episode of Abuse.
9.2In any circumstances where the person witnesses a resident being abused and the resident is in immediate danger, the person should intervene or seek help to stop the behavior to prevent further harm or injury to the resident. He/she should inform or send for the person in chargeor the most senior nurse on duty. However, the person should not confront the perpetrator.
9.3Where a person suspects that abuse may be occurring (as per abuse indicators, Appendix 1) the person should report the suspicion to the person in charge or most senior nurse on duty as soon as he/she suspects that abuse is occurring.
9.4Where a resident or representative approaches a staff member to discuss or report an incident of elder abuse, a safe and private place should be used e.g. resident’s bedroom. The staff member should listen sensitively and actively to the resident. Staff should not ask leading questions. The staff member should inform the resident /representative that he/she will need to report the incident to the person in charge or senior nurse on duty.
9.5It is important that when talking to a resident about abuse that staff should consider their own assumptions about abuse. The staff member should be aware that they may hear something unexpected and/or shocking and must remain respectful, empathetic and must not appear judgmental.
9.6It is important that staff listen to not only what the resident is saying but how he. /she is saying it, including body language and gestures. This will allow for a fuller meaning of what is being said.
9.7
9.8To demonstrate that the staff member is actively listening:
■Remove physical barriers between the staff member and resident e.g. table.
■Make eye contact.
■Lean slightly towards the resident
■Use encouraging responses e.g. nods, mming
9.9Where any of the persons identified in 9.1 above receives informationabout an incident of abuse, including where it is a direct disclosure from a resident or where a resident is upset and distressed about an abusive incident, the person must adhere to the following:
■Stay calm
■Listen carefully.
■Do not appear shocked or display negative emotions
■Do not press the individual for details
■Do not make judgments
■Do not promise to keep secrets
■Do not give sweeping reassurances
■Inform the individual that he/she will need to report the incident.
■Inform the person in charge or the most senior nurse on duty without delay.
9.10Where the person is a registered nurse, he/he must carry out an immediate assessment of the resident to look for any signs of injury or adverse effects and the need for medical attention and liaise immediately with the person in chargeor the most senior nurse on duty.
10.0Responsibilities ofthe Nurse in Charge following Receipt of an Allegation or Suspicion of Abuse.
(Nurse in Charge at the time of the reporting of abuse refers to either the person in charge or the most senior nurse on duty at the time that the report is made).
10.1The safety and wellbeing of the resident will be paramount in all situations where there is a suspicion or allegation that they have been abused or are at risk of abuse.
10.2On receipt of the report, the nurse in charge will carry out an assessment of the resident, if this has not already been done and identify any injuries or adverse effects that have been suffered by the resident.
10.3A medical examination must be performed immediately in cases of suspected physical and sexual abuse. In this case, the nurse in charge must record the presence of any injuries, harm and / or indicators of abuse. He /she must ensure that possible forensic evidence is not contaminated or removed so therefore the medical examination should take place prior to the suspected victim being bathed or washed.
10.4Where there is evidence of injury or harm, the nurse in charge will arrange for medical attention as appropriate either through contacting the resident’s GP or transferring the resident to hospital.