Clinical update

Safeguarding older people in care homes: recommendations on policy, training and culture

Guidance from NICE on spotting signs of neglect and abuse and what action to take next

The latest National Institute for Health and Care Excellence guidance on spotting signs of neglect and abuse, and what action care home staff should take next

Essential information

According to the Care Quality Commission (CQC), there are more than 10,800 residential care homes and 4,200 nursing homes in the UK.

They provide support to around 410,000 older people and younger adults with disabilities, mental health issues or complex support needs.

They may also provide respite care, including for day visitors.

As many residents rely on others for support and care, they face increased risks of abuse and neglect.

In its

...

The latest National Institute for Health and Care Excellence guidance on spotting signs of neglect and abuse, and what action care home staff should take next

Around 410,000 older people are in residential care or nursing homes
Around 410,000 older people are in residential care or nursing homes Picture: iStock

Essential information

According to the Care Quality Commission (CQC), there are more than 10,800 residential care homes and 4,200 nursing homes in the UK.

They provide support to around 410,000 older people and younger adults with disabilities, mental health issues or complex support needs.

They may also provide respite care, including for day visitors.

As many residents rely on others for support and care, they face increased risks of abuse and neglect.

In its most recent report, the CQC rates the quality of the majority of the care provided as either good or outstanding.

However, 21% of nursing homes and 14% of care homes need improvement, while 2% of nursing homes and 1% of care homes are deemed inadequate.

What’s new?

In February, the National Institute for Health and Care Excellence (NICE) published Safeguarding Adults in Care Homes. This covers the safeguarding process from when a concern is first identified, through to formal safeguarding enquiries under section 42 of the Care Act 2014. There are recommendations on policy, training and care home culture.

‘To keep people safe, everyone working in care homes, health and social care staff, families and care home residents themselves need to know what abuse and neglect looks like and what to do if they see it,’ states the guidance.

Specifically, it includes recommendations on induction and training, care home culture and management, indicators of individual and organisational abuse and neglect, plus individual actions to take if abuse or neglect is suspected.

It also explains how care home safeguarding leads and local authorities should respond to reports.

How you can help your residents

In its own guidance on the issue, the RCN says safeguarding is everyone’s business, with all professionals – and organisations – doing everything they can to ensure those at risk are protected.

As the NICE guidance shows, neglect and abuse can take many forms. Abuse may be physical, sexual, psychological, financial and material or discriminatory.

Perpetrators may be volunteers, visitors, family members or carers, as well as care home staff.

While some indicators can be similar to signs of distress or behaviours arising from other causes – including dementia, autism and learning disability – the possibility of abuse or neglect should always be considered, says NICE.

If you suspect abuse or neglect, you must act, not assume someone else will, NICE advises.

Initially ensure no one is in immediate danger. Call 999 if they are and stay with the person until help arrives. Once the resident is safe, you can begin gathering and recording information.

Depending on the risks the resident is facing and who the alleged abuser is, consider who should be notified immediately.

Do not investigate the situation yourself, as this may cause problems for the police or other investigations and enquiries, NICE says.

Expert comment

 Elizabeth Walton, designated nurse safeguarding adults, Mental Capacity Act and Prevent lead, Salford Clinical Commissioning Group (CCG), and a member of the guideline committee

Elizabeth Walton, designated nurse safeguarding adults, Mental Capacity Act and Prevent lead, Salford Clinical Commissioning Group (CCG), and a member of the guideline committee

‘Care homes have a significant role in protecting some of our most vulnerable people from neglect and abuse, playing a fundamental part in safeguarding. We hope this guidance encourages nursing staff to think about what safeguarding means to them.

‘Alongside their colleagues in healthcare, nurses can make a huge difference in safeguarding. We can recognise signs other professionals may miss, with a high level of expertise on how conditions progress or deteriorate. We also have good communication skills.

‘Without our knowledge, a number of safeguarding issues could be missed, particularly in the early stages. If we can help nurses understand more about safeguarding concerns, we can prevent abuse further down the line.

‘Nurses should think of themselves as advocates, being the voice of their patients.’

Lynne Pearce is a health journalist


Find out more

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to nursingolderpeople.com
  • Bi-monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs