Safeguarding Vulnerable Adults. Matthew Croughton RMN MSc
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1 Safeguarding Vulnerable Adults Matthew Croughton RMN MSc
2 Aims of Presentation! What can cause and/or influence vulnerability! Types of abuse! The 6 Safeguarding Principles! Assessing vulnerability & Mental Capacity! Raising concerns
3 What can cause and/or influence vulnerability? The Department of Health defines a vulnerable adult as a person aged 18 years or over who is or may be in need of community care services by reason of mental or other disability, age or illness, and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation. Boland et al. (2013)
4 What can cause and/or influence vulnerability?! Lack of mental capacity.! Increasing age.! Being physically dependent on others.! Low self-esteem.! Previous history of abuse.! Negative experiences of disclosing abuse.! Social isolation.! Lack of access to health and social services or high-quality information. Boland et al. (2013)
5 Types of abuse Physical Abuse! Assault! Hitting! Slapping! punching! kicking! hair-pulling! Biting! pushing! scalding and burning! inappropriate or unlawful use of restraint! misuse of medication (e.g. over-sedation) Social Care Institute for Excellence
6 Recognising Physical Abuse! no explanation for injuries or inconsistency with the account of what happened! injuries are inconsistent with the person s lifestyle! frequent injuries! subdued or changed behaviour in the presence of a particular person! failure to seek medical treatment or frequent changes of GP! signs of malnutrition Social Care Institute for Excellence
7 Types of abuse Sexual Abuse! Rape, attempted rape or sexual assault! Any sexual activity that the person lacks the capacity to consent to! inappropriate looking, sexual teasing or! innuendo or sexual harassment! sexual photography or forced use of pornography or witnessing of sexual acts! indecent exposure. Social Care Institute for Excellence
8 Recognising Sexual Abuse! bruising, particularly to the thighs, buttocks and upper arms and marks on the neck! pregnancy in a woman who is unable to consent to sexual intercourse! the uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude! incontinence not related to any medical diagnosis! self-harming! poor concentration, withdrawal, sleep disturbance! fear of receiving help with personal care Social Care Institute for Excellence
9 Types of abuse Psychological Abuse! enforced social isolation preventing someone accessing services, educational and social opportunities and seeing friends! preventing the expression of choice and opinion! cyber bullying! threats of harm or abandonment! intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse! removing mobility or communication aids or intentionally leaving someone unattended when they need assistance! preventing someone from meeting their religious and cultural needs Social Care Institute for Excellence
10 Recognising Psychological Abuse! withdrawal or change in the psychological state of the person! Insomnia! Low self-esteem! uncooperative and/or aggressive behaviour! a change of appetite, weight loss/gain! signs of distress: tearfulness, anger! apparent false claims, by someone involved with the person, to attract unnecessary treatment Social Care Institute for Excellence
11 Types of Abuse Financial/ Material Abuse! theft of money or possessions! denying assistance to access benefits! denying assistance to manage/monitor financial affairs! misuse of personal allowance in a care home! misuse of benefits or direct payments in a family home! someone moving into a person s home and living rent free without agreement or under duress! exploitation of a person s money or assets, e.g. unauthorised use of a car! misuse of a power of attorney, deputy, appointeeship or other legal authority! rogue trading e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship. Social Care Institute for Excellence
12 Recognising Financial/Material Abuse! Unexplained deficit of money! Unusual interest in assets by family or others! Financial debts or arrears inconsistent with perceived income! unnecessary property repairs! the person allocated to manage financial affairs is evasive or uncooperative! failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so Social Care Institute for Excellence
13 Other categories of abuse! Domestic violence! Modern Slavery! Discriminatory! Organisational/institutional! Neglect
14 The 6 Safeguarding Principles! Empowerment - People being supported and encouraged to make their own decisions and informed consent.! Prevention It is better to take action before harm occurs.! Proportionality The least intrusive response appropriate to the risk presented.
15 The 6 Safeguarding Principles! Protection Support and representation for those in greatest need.! Partnership Local solutions through services working with their communities.! Accountability Accountability and transparency in delivering safeguarding. In England and Wales, statutory requirements for safeguarding adults are set out in the Department of Health document No Secrets. This establishes the principles of multi-agency working and sets out how this should be achieved locally.
16 Assessing Vulnerability! Assessing the potential vulnerability or safeguarding concerns requires the same skills as any other assessment, and is based on the same principles of a person-centred approach! People with complex needs may require more time to be spent with them in order to promote disclosure.! Key point: Does the individual have the ability or capacity to protect themselves or promote their interests?
17 Mental Capacity Five Principles Which Underpin The Mental Capacity Act:! You must always assume a person has capacity unless it is proved otherwise! You must take all practicable steps to enable people to make their own decisions! You must not assume incapacity simply because someone makes an unwise decision! Always act, or decide, for a person without capacity in their best interests! Carefully consider actions to ensure the least restrictive option is taken
18 Assessing Capacity - Brief Follow the 2 stage test for capacity:! Stage 1: Does the person have an impairment of the mind or brain (temporary or permanent)? If Yes:! Stage 2: Is the person able to:! Understand the decision they need to make and why they need to make it?! Understand, retain, use and weigh information relevant to the decision?! Understand the consequences of making, or not making, this decision?! Communicate their decision by any means (i.e. speech, sign language)? Failure on one point will determine lack of capacity
19 When to raise a concern Key concept: Significant harm Other factors include:! the vulnerability of the individual! the nature and extent of the abuse! the length of time it has been occurring! the effect of the abuse on the individual! the risk of repeated or increasingly serious abuse! the likelihood that other vulnerable individuals may also be put at risk! whether criminal offences are involved. BMA GP Toolkit
20 How to raise a concern! Safeguarding referrals should be directed towards your Local Authority Social Services.! Local Authorities have responsibilities to coordinate multi-agency responses to safeguarding concerns.! Your Local Authority will have a Safeguarding referral document these usually vary depending on whether it is a child or an adult being referred.! If unsure: Refer.
21 Further Information! Social Care Institute for Excellence! Safeguarding Vulnerable Adults a General Practitioner s Toolkit! No Secrets Department of Health! Office of the Public Guardian safeguarding Policy! The Care Act 2015! The Mental Capacity Act
22 References! Patient.info Vulnerable Adults! Boland B, Burnage J, Chowhan H; Safeguarding adults at risk of harm. BMJ May 14;346:f2716. doi: /bmj.f2716.! No Secrets: guidance on protecting vulnerable patients in care; Dept of Health, March 2000! Vulnerable adults and confidentiality; BMA! Social Care Institute for Excellence! Safeguarding Vulnerable Adults a General Practitioner s Toolkit! No Secrets Department of Health! Office of the Public Guardian safeguarding Policy! The Care Act 2015! The Mental Capacity Act
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Page 1 of 12 Policy Applies to: All Mercy Hospital staff. Compliance by Credentialed Specialists or Allied Health Professionals, contractors, visitors and patients will be facilitated by Mercy Hospital
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Resident Rights If you are considering placing a loved one in a nursing home or know of someone already receiving care, it is important to know under Michigan law, residents of long term care are guaranteed