Memorandum by The National Care Homes
Association (EA40)
INTRODUCTION
The National Care Homes Association is a not
for profit organisation representing providers of residential
and domiciliary care to vulnerable members of our society, throughout
the United Kingdom. The Company is limited by guarantee and has
a Board of 10 Directors who assume strategic responsibility for
the Association, whilst the Chief Executive Officer undertakes
all operational responsibilities for the Association based at
the London based Headquarters. All Directors are volunteers and
are either currently providers of care or have been providers.
The Association represents approximately 4,000
providers and works closely with the local Associations to ensure
that both local and national agendas are addressed at all times.
The NCHA has been at the forefront of many initiatives promoting
good practice, with members our Board and our CEO representing
the sector on various Taskforces, Steering Groups, Workforce Development
Partnership Boards and Training Bodies.
HOW PREVALENT
IS ADULT
ABUSE?
Abuse of vulnerable people within our society
is regrettably a well-versed topic of interest as its implications
are far reaching and its detection is often difficult. The forms
of abuse suffered by victims vary, however the impact is no less
devastating, and the environments within which it occurs range
across the breadth of all provisions of care.
It is important to note that alerts on abuse
throughout the country have come from within the private, voluntary
and statutory sector, in both residential and home care settings,
no part of the sector is exempt from this issue. Research on the
subject has not been able to present a "reasonably coherent
picture" of the extent or nature or indeed the dynamics of
abuse (Behind Closed Doors by Susan Greaves).
Following guidance from the Department, all
Local Authorities are now required to have a monitoring process
for cases involving abuse of vulnerable members of society and
most show that the levels of Adult Protection Alerts have increased
significantly, however statistics are not clear about how many
are proven! Statistics in the South East show that the greatest
number of alerts is raised due to physical abuse, with neglect
and financial abuse following close behind. Statistics further
highlighted that allegations of abuse in service users own homes
was more widely reported and often raised by social services staff.
Evidence gathering, once alerts are raised,
is not always an easy or simple task. In one area, in 2002-03
only 29% of alerts were proven, with a further 29% being monitored
on the basis of "not enough evidence", 26% were not
investigated and 16% were discounted. Physical abuse is often
the most easily proven; it is the other forms, which are challenging!
WHAT ARE
THE CAUSES
OF ELDER
ABUSE?
Evidence would suggest that abuse of vulnerable
people is often subtle and systematic. Abusers are people who
have been placed in positions of responsibility and trust. Family
members, spouses and staff are the three most frequent groups
of abusers according to evidence gathered by a local authority
in the South East.
The vulnerability of older people in residential
and home care settings creates environments where poor training
and poor practice contribute to incidents leading to abuse. In
cases where ethnic minorities are involved the language barrier
alongside cultural taboos has increased the vulnerability of older
people within the family set up.
Anecdotal evidence has also indicated that financial
stability within family set ups has created an environment where
abuse could develop. Financial incentives for care to be provided
at home by family members can put older people at risk if not
appropriately monitored.
It must also be noted that incidents involving
older people suffering with varied degrees of dementia are higher
and yet more difficult to prove, especially in home care settings.
THE SETTINGS
OF ELDER
ABUSE
Residential care setting are well prepared to
monitor care provided through recent legislation which highlights
the need to training in Adult Protection and the need to ensure
appropriate mechanisms are in place to record incidents within
the setting. There is no doubt that poor practice within all settings
delivering care, is the cause most widely expressed as the reason
for incidents of abuse.
In incidents where neglect has been highlighted
much has been documented by carers pointing to a shortage of time
due to lack of staff or use of agencies, who may not be appropriately
briefed or trained. There are also indicators that staff working
within group settings are more likely to detect changes in service
users behaviour, which would alert them to poor practice, this
safety mechanism does not exist for carers working in isolation.
In a report presented to an Adult Protection
Management Group in January 2003 in the South East statistics
indicated that 41 alerts were raised regarding people abused in
their own homes, nine in residential settings, two in a public
place, three in day care centres and three in a setting which
was not the persons own home. This illustrates that abuse can
occur in most settings, however the setting we see as preferred
options afford perpetrators the greatest opportunity!
WHAT CAN
BE DONE
ABOUT IT?
Much has been done in recent years through legislation
and publication to highlight the issues surrounding the protection
of vulnerable adults. "No Secrets" encouraged Local
Authorities to set about promoting good practice issues for all
providers. Alongside this, providers have been encouraged to incorporate
policies, which promote whistle blowing in an effort to eliminate
poor practice within their management practice.
It is important to address the issues around
staff recruitment and retention within the sector to get to the
root of the problem. The sector faces difficulties, which compound
the issues, of poor image and poor pay. Media attention only promotes
these images and so does not allow the sector to move forward
into the professional status promoted by the modernising agenda.
It is difficult to imagine how we can move forward with the agenda
to have a skilled workforce when providers are limited by the
income they receive, which in turn makes it difficult to attract
people to the sector who will deliver very skilled services on
a minimum wage! Action on Elder Abuse has done some credible work
reinforcing this position.
Staff confidence and competences hold the key
to resolving some of the issues faced. The policy of "whistle-blowing"
has created a tool, which when used appropriately, ensures the
safety of vulnerable older people. It is important for providers
and commissioners to have to work together to ensure that this
policy has appropriate status and support at all levels. Advocacy
schemes should have a role; especially in home care settings,
to ensure that service users have the support they need when alerts
are raised.
A great deal of the modernising agenda has concentrated
on staff competences through the education and training route
and the registration route. In order to ensure that the message
is consistent we must ensure that carers not only have their status
raised as trained professional but also receive the financial
rewards for their commitment. A good training strategy with induction
and foundation at its start and regular assessment and supervision
ongoing will create the good practice we all strive for.
Recruitment procedures are an important part
of prevention when considering issues of practice. Good robust
practice on recruitment is necessary and alongside the paper exercise
required by the practice in the earlier part of employment. Employers
are hampered by employment law once employment is confirmed, however
adequate staff supervision, and assessment and appraisal systems,
though time consuming, are recommended by NCHA to ensure poor
practice can not only be highlighted but also dealt with.
The role of NCSC and commissioners is clear
in the process of adult protection and practice has shown inspectors
to be vigilant. It is however important to promote provider participation
within the process, whilst recognising this may not always be
possible, the issue of lack of involvement, and the reluctance
of inspectors and commissioners to complete the process is commented
on. Considering the number of unfounded alerts raised, there must
be an undertaking to debrief the carers and reassure them about
the outcomes. Both positive and negative messages from the investigators
will lead to a more open forum and collective responsibility to
promote good practice.
The issue of informal carers creates some real
tensions within the adult protection arena. The residential and
home care settings there are formal channels monitoring, protecting
and supporting the service users. The Direct Payment scheme will
allow people, who would not otherwise gain employment through
the normal channels, to deliver care, slipping through the net
set to protect the vulnerable. It will be important to ensure
tracking methods are in place to eliminate the real risks of informal
caring. Statistics have shown that family members are amongst
those most likely to abuse for a variety of reasons, and financial
abuse is often the most common cause!
There is no doubt that there must be more robust
systems in place to enable older people to report any form of
abuse that they may find themselves faced with. People in positions
of authority or responsibility have to create a culture, which
recognises the signs and also promotes openness. The place of
advocacy schemes needs to be considered in this context ensuring
that those involved will have a clear understanding of pathways
to follow which involve providers not see them as the opposition.
RECOMMENDATION FOR
NATIONAL AND
LOCAL STRATEGY
At national level it is imperative that guidance
is issued relating to the manner in which individuals will employ
carers under the Direct Payment scheme. The National Care Homes
Association would welcome clarity, which would ensure that vulnerable
older people do not face unnecessary difficulty. Bearing in mind
the statistics shared earlier must ensure that abuse in home care
settings is not compounded by the lack of clarity on people employed
under this scheme.
It would also be of value to have a national
panel, which includes stakeholders, to consider practice throughout
the country with a view to promoting good practice, at the same
time as reviewing the data available. The value of this would
be to ensure that all stakeholders are signed up to the same agendas
and working within consistent guideline. There is little to reinvent
the wheel if we know that methods adopted in one part of the country
have lead to a decline in alerts, it can be replicated.
At local level it is important to ensure that
providers are included in issues relating to training on investigations
as this will clarify procedure which may be seen as over jealous
on the part of inspectors and commissioners. In turn providers
will have a responsibility to carers to include them in the process.
Recognising the importance of the process used
to undertake, investigations there must be a clear understanding
that at the point an alert is picked up the assumption must be
that the allegation may be unfounded. This will ensure that over
jealous inspectors from both NCSC and commissioners is fair and
equitable, understanding the human rights of all individuals involved.
There is a great deal of evidence, which clearly suggests that
this is often forgotten and the allegation is used as the basis
to prove guilt under any circumstance.
Local Authorities have a responsibility to ensure
that the Adult Protection Committee enable providers to have a
voice alongside Relatives Associations and organisations aligned
to Elder Abuse. This will assist provider group to demystify the
process. There is a marked reluctance at time to raise issues
with investigators as the process can be over intrusive and leave
a stigma.
Communication with providers could be the key,
not only through web pages, as this illustrates a willingness
to work in real partnership, one of equals! Although the numbers
suffering abuse may be small we have a responsibility to work
towards a "nil tolerance" attitude, protecting the service
user and the millions of carers who deliver exceptional care but
are tarnished with the same brush.
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