Explain that if anybody is upset by anything we discuss they are free to leave and have a cup of tea etc. Experienced and this training may be an example of teaching grandma and grandpa to suck eggs. Recently the government commissioned work to look into elder abuse. It was shelved. Why? The amount of information regarding safeguarding they received would have been too expensive to sort out. Situation when a safeguarding issue has been handled badly? Talk to the staff member involved and hear the dreadful words “they won’t raise an issue again” Need to see other modules of care to be able to recognise abuse, if its all you have known then it will be the norm.
We also need to use our own personal value base. We all have one, where has this come from? Know in your self if something is right or wrong.
Staff on the front line are the most important – you need to feel supported by your line manager Identify staff feelings experienced when involved in an instance of abuse Stress the importance of off-loading Identify support systems e.g. managers, supervisors, colleagues
Birthday – sexual abuse exercise Identify participants feelings, relate the answers to the vulnerable people out there. Safeguarding fails due to lack of communication. Ask how must they be feeling?, living with abuse, unable to speak/tell anyone about it What can we do? Lead the discussion into Communication, building trust, relationships, honesty
Action on Elder Abuse in 1992 but widely quoted. Used by Age UK in various publicity from time to time and referenced in Elder Abuse– Report of Health Select Committee in 2004 Reasons – don’t know they are being abused, or it may be the norm, scared, cannot communicate, don’t trust staff, don’t know who to tell or how to tell someone. Years past it used to be the duty of a wife to have sex when the husband wanted it,
National statistics compiled by Dept of Health Action Elder Abuse 1992
(Adult Protection data monitoring 2004-2006 – Action on Elder Abuse) Procedural practice
Definition AEA Activity Analysis on behalf of DH
Statement to develop discussion Statistics from Community and District Nurses Association 2003
Guardian, 23 Nov 2005 Handled with Care? CSCI, Feb 2006 Malnutrition e.g. staff don’t care, short staffed, not feeding or assisting people to eat, inadequate or no recording, dentures not suitable, staff not bothered to assist a person with a sensory impairments re- glasses or hearing aid so person does not know food is on the table or cannot see to eat, training for chefs – food not nutritional, Do not like the food on offer, no choice, cold food Medication e.g. short staffed, inadequate or no recording, untrained staff, staff don’t care, medication not reviewed, administering wrong medication, in the extreme – staff stealing peoples medication, staff not checking meds have been taken.
Un-intentional abuse – lack of training, not attended refresher training, staff been shown or told to do it this way, don’t know any different Do not recognise it as being abuse Statement to develop discussion
Guidance on developing multi-agency policy and procedures to protect vulnerable people from abuse 1. Partnership working – statutory agencies work together- ASC, NHS Police, housing, commissioners, regulators of care services. 2. Prevention – where possible, if the preventative strategy fails – robust procedures to deal with it 3. Collaborate/work together with public, voluntary and private sectors, service users, their carers and representative groups 4. Communication – information passed on. Recorded, All agencies communicating, putting a protection plan in place etc No Secrets guidance which has Section 7 status but no ring-fenced finances. This has hampered efforts to develop Protection of Vulnerable Adults policies, procedures and systems consistently and coherently.
Ask who they would class as a adult at risk Who is vulnerable – as anyone been vulnerable. We are all vulnerable at one time or another in our lives, e.g. child, hosp, working alone at night etc.
Action On Alder Abuse “Adult protection Data Monitoring” 9 Local Authorities Essex, Hertfordshire, Brent, Redbridge, Liverpool, Hull and East Riding of Yorkshire, Poole, Bournemouth, and Dorset in 2004 – 2006 Out of 639 referrals, only 0.78% (5) resulted in a decision to proceed with a criminal prosecution during the period of collection. However in 7.5% (48) referrals the police had taken some form of action. Criminal Justice System is no good at questioning don’t take into account a person circumstances/ medication/ when is a good time to question. Also Crown prosecution feels that vulnerable adults can be “Unreliable Witnesses” Wake of the Baby P case Haringey, North London – No dialogue between the different agencies “ Didn’t want to make things worse” In the Steven Hoskin case in 2006 in Cornwall , this was a 38 year old man with Learning Difficulties, he lived alone and a gang befriended him. They moved into his home with him and started to sell drugs from his home. He was tortured and murdered by the gang. Steven had cancelled his own care in August 2005 but was not risk assessed. He made 12 calls to police over matters including threats. Most of the gang members were well known to the police. It was recognised that the multi disciplinary representatives did not communicate to each other ( communication is the key). Zebra / Lion – Always attack the most vulnerable. Steven Hoskin example. Why: Blame culture Protect own turf Protect yourself
Break down and discuss in more detail Single act – Stressed, lashing out Repeated acts - un-intentional. Training issue e.g. moving and handling, using wrong moving procedures ASK WHY Repeated- perpetrator has not been caught, not seen as abuse, person receiving the abuse does not tell anyone Neglect or omission – failure in the provision of care due to neglect or just not caring, too busy, short staffed, cut corners Sexual transaction - David Jenkins – STRESS - 12 years ago Judge was discriminating against people with a L/D David Jenkins case 12 years ago D.J was a Support worker of a Residential home for people with learning disabilities, within the home was a 25 year old female customer who had a brain injury had severe learning disabilities. Pregnant – DNA proved that she had been raped by the Support worker, experts told court she did not understand anything about sex and so she could not consent, Judge ruled that even if she didn’t understand anything about sex she would have acted on her animal instincts and he walked free. He was sacked from his job, he wasn’t convicted he could walk into another job- no POVA list then it wasn’t a criminal offence. POVA (July 2004 introduced via Care Standards Act 200) now replace by Vetting & Barring Scheme – ENSURES UNSUITABLE PEOPLE DON’T WORK AGAIN WITH IN CARE SETTING – COULD BE SACKED, RESIGNED OVER ALLEGATIONS OF ABUSE GO ONTO THE POVA LIST. Vetting & Barring Scheme is operated by the ISA Independent Safeguarding Authority (under Safeguarding Vulnerable Groups Act 2006) – ability to bar people from working/volunteering with children / vulnerable adults Tuesday 20 January 2009 to a new referral address. This is: Independent Safeguarding Authority, PO Box 181, DARLINGTON DL1 9FA. CSCI, health Care Comminsion, MHA Commision are now merged CQC, Care Quality Commission from 1/4/09. CQC will register all providers of health and Social Care services against a single set of registration requirements, focused on safety and quality of care. Illegal if providers provide services within the scope of the new framework and do not register with CQC. Primary medical and primary dental care also included. Approx 8500 GP practices and 9000 dental practices required to register. Registration requirements stipulate what they must do not how. Registration system introduced 2010/11 1/4/09 CQC take over the function of CSCI, Health Care Commission and The mental Health Act commission. Some aspects implemented April2009
Split into groups and use the Recognising Abuse exercise sheets. Give each group a type and ask them to come up with different answers Discrimination can be left for a group discussion Group to complete the exercise sheets Physical Psychological Neglect Discriminatory Institutional Sexual Financial
Contrary to what you may think a woman cannot commit rape, why? What is the legal age of homosexual consenting sex? 16 What is the legal age for lesbian consenting sex? There is none!
Exercise using Indicators of Abuse sheets Need to address – How a worker may be alerted to an instance of abuse – may witness it, may overhear a conversation, maybe a disclosure, maybe a third party disclosure Physical Abuse: History of unexplained falls or minor injuries. Bruising, particularly if its in well protected areas or clustered. Finger marks. Burns in unusual places. Slap marks. Kick marks. Cuts/ injuries especially to head/ face/ scalp. Injury shape similar to object. Fractures. Weight loss due to malnutrition when not living alone. Drowsiness (due to too much medication). Sexual Abuse: Self inflicted injury. Disturbed sleep patterns. Recent difficulty in walking or sitting. Torn, stained bloody underclothes. Love bites. Bleeding. Torn rectal or vaginal area. Change in usual behaviour. Withdrawal, choosing to spend majority of time alone. Overt sexual behaviour/ language from the vulnerable person. Pregnancy. STD. Psychological Abuse: Isolation (vulnerable person confined to one room and denied social contact). Change in appetite, unusual weight loss/ gain. Unkempt, unwashed smell of urine/ faeces. Being left in dirty clothes. Unexplained paranoia, excessive fears. Confusion, agitation. Inappropriately dressed. Insomnia or excessive need for sleep.
KEY POINTS – Indicators are only indicators. Some indicators may have simple, innocent explanation. Financial: Unexplained or sudden inability to pay bills. Unexplained or sudden withdrawal of money from accounts. Disparity between assets and satisfactory living conditions. Excessive interest by family members and other people in the vulnerable persons assets . Neglect: Need to address self-harm and self-neglect as not being safeguarding concerns but a change in such behaviour as a possible indication of abuse Poor care standards. Poor personal hygiene, unexplained injuries. Institutional: Poor care standards. Lack of positive responses to complex needs. Rigid routines. Inadequate staffing or an insufficient knowledge base within the service.
Figures taken from ‘NHS The Information Centre Abuse of Vulnerable Adults in England 2010-11: Experimental Statistics Final Report’ Put up a mirror and we can see the perpetrator. Mention that these are only statistics, just what is reported could be tip of the iceberg Ask group why they would maybe not report abuse if they were a vulnerable adult
EXERCISE Refer to additional training notes – KEY MESSAGE – Doing nothing is not an option. What is the worst thing that could happen if suspected abuse is not acted upon - Death Split into 3 groups. Traffic Lights discuss each card and all agree with where the card should be placed. Red Do something Amber report Green ok. Choose one card that you had the most discussion on. Bring back to the group Some of the things that I could here was “you have got to look into it – She might be – well I don’t know – you only know a little bit. You need more information, Not always flinching, quiet, negative -Mention the case in Derby disclosure of abuse with a male carer (engagement party). Sally has L/D said she had a boyfriend in the care home where she lived called Dave, no-one believed her. Until one day when staff told her he was getting engaged and was having a party. Sally said I’m Dave’s girlfriend and started crying. Disclosed that Dave had said it was their secret and not to tell anyone and described how Dave touched her. Investigation found semen on a tissue in a waste basket Because of the evidence – probably the police would act under The Sex Offences Act 2003
Refer to additional training notes Read out case study: hand out case study to discuss, each group discuss and answer questions. Refer to training note for points to cover
DON’T INTERRUPT – UNLESS they are about to tell you something that may need to be investigated by the police – in which case you have to stop them from telling you anymore. This keeps the evidence intact for the police
AP1 Form should be used.
Intended to encourage and enable staff to raise serious concerns rather than overlook a problem or discussing it externally. Public Interest Disclosure Act 1988 provides you with a certain level of legal protection if you wish to raise legitimate concerns Eg of concerns Is unlawfull Against councils contract procedure and financial rules or other policies Falls below established standards or practice or Amounts to improper cionduct
Capacity – Mental ability to make a decision, It is time specific and decision specific. Establishing 1 decision a t 1 particular time Gives clear guidance What to do to help someone make a decision How to work out if someone can make their own decision What to do if someone cannot make decisions The person must be central to the decision making process The MCA applies to everyone who works in health and social care and involved in care, treatment or support of people who lack capacity to make their own decisions / consent to treatment or care that is proposed In relation to safeguarding - Risks must be monitored and people must feel supported in taking those risks
Observation, build trust, communication, report, record, alert a manager to suspected / abuse
Perpetrators of abuse do not stand out, they are just like you and I. Anyone can abuse but not all people do abuse. We need to put a stop to it.
Safeguarding of Adults at Risk Welcome 31st March 2012 Neil Lee
Safeguarding of Adults at Risk House Keeping Group Agreement
Aims To explore personal values and beliefs To enable staff to promote the safeguarding of all adults at risk To establish a shared understanding of best working practice in offering support To understand procedures when reporting abuse
Objectives Explain what is meant by the term “Adult at Risk” Describe what is meant by abuse List signs and indicators of abuse Discuss how to differentiate between causes for concern and safeguarding issues Demonstrate how to respond appropriately Identify policy and procedure
Introductions Each person introduce themselves Tell us where you work and who are the adults you work Warm up exercise
True or False? Up to 10% of people over 65 are abused each year TRUE – as far as we know People who are abused may not know they are being abused TRUE Can you give some reasons?
True or False? In order of ‘most likely’ (1) to ‘least likely’ (3) Woman 3 (25%) Man 1 (45%) Man and woman together 2 (33%) Over 70% of elder abuse affects people over 70 years old TRUE – in fact it is nearly 80%
True or False? Over 60% of elder abuse is experienced by women TRUE – in fact it is nearly 70% - with earlier statistic – 52% of elder abuse affects women over 70 Some forms of abuse violate people’s human rights FALSE ALL forms of abuse violate human rights
True or False? Drug Users and alcoholics don’t count as vulnerable adults FALSE Most elder abuse occurs in care homes FALSE Most occurs in people’s own homes
True or False? Abuse is another term for domestic violence IT DEPENDS Vulnerable adults can experience domestic violence but not all domestic violence involves the vulnerable adults we are discussing Most Community or District Nurses encounter elder abuse each year TRUE 88% reported so in a survey but this is only elder abuse
True or False? A fifth of older people living in care homes suffer from malnutrition TRUE Any examples? Nearly half of all nursing and care homes fail to reach national minimum standards for managing residents medication TRUE Any examples?
True or False? Abuse is not always deliberate TRUE Any examples? “Grooming” is a term that only applies to paedophile offences FALSE
No Secrets 2000 Partnership Prevention Guidance – inter-agency policies, procedures and joint protocols Communication
Adult at Risk“Adult at Risk” is a term used to describe a person who Isan adult aged 18 years and overANDwho is or may be in need of community care services by reason of mental or other disability, age or illnessANDwho is or may be unable to take care of him or herself or take steps to protect him or herself from significant harm or exploitation”[No Secrets, DOH, 2000]
This Includes People Older people With a Learning Disability With a Physical Disability With Mental Health problems With Dementia With Brain injuries With Drug & Alcohol problems With a Sensory disability
Definition of Abuse ‘Abuse is a violation of an individual’s human and civil rights by any other person or persons. It may consist of a single act or repeated acts. It may be an act of neglect, or omission, or it may occur when a adult at risk is persuaded to enter into a financial or sexual transaction to which he or she has not consented or cannot consent’[No Secrets, DOH, 2000]
Defining Abuse Physical Abuse – Including hitting, slapping, kicking, misuse of medications, over or under feeding, restraint or inappropriate sanctions Sexual Abuse – Through non- consensual sexual actions, rape, sexual assault / or pressured into consenting, sexual explicit conversations Psychological/ Emotional Abuse – Through non-physical means, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, verbal abuse, isolation or withdrawal from supportive networks.
Defining Abuse (cont) Financial/Material Abuse – Including theft, fraud, exploitation of wills, property, inheritance, possessions or benefits Neglect – Ignoring medical and/or physical care needs, failure to provide access to health, social care or educational services, withholding necessities of life, e.g. medication, adequate nutrition, heating , lack of cleaning Discriminatory – Based on someones race, culture, faith, age, gender, disability, sexuality or capacity and other forms of harassment, slurs or similar treatment Institutional – Harm or distress as a result of poor management, training or practice. Choice taken away, Care given at set times to make it easier for staff and the organisation
Indicators, Signs & Signalsof Abuse Physical - Sleepy, Bilateral marks, injuries in various stages of healing, hair loss, marks on hidden parts of the body, mouth ulcers, burns, bruises, brakes, scratches Sexual – Difficulty in sitting/walking, use of sexual words/gestures, body fluids, pregnancy, blood stains, difficulty in going the toilet, STIs Psychological/Emotional – Hesitation to talk openly, emotional agitation, unusual behaviour such as sucking thumbs, biting, rocking, confusion, unexplained fear
Indicators, Signs & Signalsof abuse (cont) Financial – Lack of heating, lack of food in the cupboards, referral to another person for money related matters, borrowing money, unexplained bank withdrawals Neglect/Environmental – Dehydration, malnourishment, weight loss without illness, pressure sores, lice, dirty, mouth rashes, smells, doors left open/locked, unable to use mobility aids, glasses, hearing aids Institutional- Restricted visiting, no stimulus, lack of bedding/clothing, no privacy for visitors Consider what might you see/hear/feel/smell
Who Can Be An Abuser? Partner Other family member Health care worker Volunteer Social care staff Other vulnerable adult Neighbour/ friend Stranger Other
Relationship Figures 2010/ 11 Partner 7% This is only what we know Other family member 18% from what is reported. Health care worker 3% The true figures could Volunteer 0% be double, triple......... Social care staff 25% Other professional 3% Other vulnerable adult 13% Neighbour/ friend 6% Stranger 2% Not known 14% Other 8%
Dealing With A Concern/Allegation Of AbuseDO- Inform a Line Manager Take what the person says seriously Stay calm, try not to show shock Listen carefully & allow them to share information Support & reassure the person throughout, it’s not their fault Protect evidence Tell the person you must discuss with a manager Ensure the person is safe Write down what was said Inform police if it’s a crime Maintain Confidentiality
Dealing With A Concern/Allegation Of Abuse (cont)DON’T- Promise to keep secrets Press the person for more information Make promises you cannot keep Don’t interrupt Do not be judgemental or ‘explain’ the situation away Do not contact the alleged abuser Don’t be persuaded to keep quiet Do not attempt to investigate yourselfFailure to report known or suspected abuse is an act of omissionand a failure under duty of care – making the failure abuse itself
Writing a Report Make a note of what has been disclosed to you as soon as possible Ensure that you state the facts and not opinion Date and sign your report, clearly stating your name Write down what was said using the exact words if possible or what you observed, including dates and times Describe the circumstances in which the disclosure was made, what you observed concerning actions and behaviour Say where it happened and who else was there at the time, stating full names if possible Consider who, what, when, where, why Any immediate action that has been taken
Public Interest Disclosure Act ‘Whistleblowing’Aim: Last resort option Provides an avenue to raise concerns and receive feedback on any action taken You will be protected from reprisals or victimisation Encourages employees to raise serious concerns Identity will be kept confidential for as long as possible An investigation or court case may reveal a persons identity
Mental Capacity Act 2005Key 5 Principles2. A person must be assumed to have capacity unless it is established that he lacks capacity’3. ‘A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success’4. ‘A person is not to be treated as unable to make a decision merely because he makes an unwise decision’5. ‘An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made in his best interests’6. ‘The act or decision is to be achieved in a way that is less restrictive of a person’s rights and freedom of action’
Useful Telephone Numbers Independent Safeguarding Authority – 01325 953 795 Office Public Guardian - 0300 456 0300 Police Call Centre – 101 Police Emergencies – 999 NHS Whistleblowing Hotline – 08000 724 725 Care Quality Commission (CQC) – 0300 061 6161 Public Concern At Work 020 7404 6609
How Safe are our Services? What can you do as an individual, team or organisation to help create a safer environment for the people you support
‘Abuse results in significant harm,exploitation of, the adult at risk.It may be perpetrated by anyone whohas power over the person whetherthey are a carer, relative, a paidMember of staff or professional, or asa result of persistently poor care or arigid and oppressive regime.’Steven Hoskins Video
Safeguarding Of Adults At Risk Any questions Evaluations & Certificates
“The great end of learning is notknowledge, but action”Peter Honey Neil Lee 07753283048 email@example.com Thank you