Safeguarding adults with dementia during the COVID-19 pandemic

Updated: 23 July 2021
Published in partnership with Alzheimer’s Society

Safeguarding adults with dementia is an important part of everyday work for providers of adult social care. This quick guide aims to support care providers and staff to safeguard people with dementia during the pandemic.

Although most legal restrictions have now been lifted, there remains a concern that, as disruptions to services and support will still occur, people may still be more vulnerable to abuse or neglect. This may be a result of:

Care providers and staff are still under extra pressure as you cover for others who are sick or self-isolating, and you may be worried about your own health and that of your families.

This is a time when we must all be extra vigilant and try to pick up any early signs that something isn’t right.

Make sure you are alert to the signs of abuse

People with dementia, staff, carers and family may not report abuse for a number of reasons:

  • fear of repercussions
  • not realising that what is happening is abusive
  • fear of being seen as a troublemaker

View SCIE’s quick guide to help you spot the Types and indicators of abuse.

If you have a concern that someone is being abused or neglected, it is important that you raise that concern internally, in line with your organisation’s policy and procedure. This is usually with your direct manager or supervisor, your organisation may also have a safeguarding lead.

The organisation will then consult the person where possible and gain their consent to report to external authorities such as the local authority. If the person does not consent, managers will decide whether there are grounds for overriding consent. What if a person does not want you to share their information?

Here are some useful do's and don’ts:

Do

  • Act on any concerns, suspicions or doubts.
  • In an emergency, if there is actual or immediate risk of abuse, call 999.
  • Try to ensure the immediate safety of those concerned – but not at the risk of your own safety.
  • Provide first aid if necessary and someone is available with appropriate skills.
  • Listen and clarify what the concern is / what has happened.
  • Provide reassurance and comfort; offer a cup of tea.
  • Assure the person that the matter will be taken seriously.
  • Ask the person what they want done.
  • Explain what you will need to do and who you may need to inform
  • Try to gain consent to share information as necessary.
  • Consider the person’s mental capacity to consent and seek assistance if you are uncertain.
  • Actively preserve any evidence.
  • Respect privacy as far as possible.
  • Arrange support for the alleged victim.
  • Contact the local authority children’s services if a child is, or may also be, at risk.
  • Report all your concerns to a manager in line with organisational and local multi-agency procedures.
  • Make an accurate record of what has occurred (or what has been disclosed/alleged) and what action has been taken.

Don't

  • Ignore.
  • Promise confidentiality – explain how and why the information might need to be shared.
  • Rush the person.
  • Probe or question – just record the facts and seek clarification where necessary.
  • Contaminate or disturb any evidence.
  • Interview witnesses – but do record any information volunteered by them.
  • Panic or show shock /disbelief.
  • Be judgemental.
  • Jump to conclusions.
  • Approach the alleged abuser (unless they also have care and support needs and are in your care or they are a member of your staff).
  • Gossip, only inform others on a need to know basis.
  • Put management or organisational interests before safety.

Good practice

Good quality care and practice is always a good baseline on which to ensure people are safe, their wellbeing is promoted and their human rights protected. The crisis meant that there were some easements to the Care Act 2014 and the Social Services and Well-being (Wales) Act 2014. These changes temporarily amended some of the duties and powers that local authorities have in relation to providing care. Since the inclusion of these Care Act easement powers, only eight local authorities have had need to use them and not since 29 June 2020. At the one-year review of the legislation, these easements were expired and will no longer be available through the act.

Find out more at the end of this quick guide. Let’s look here at the specific issues and how you can best support people with dementia

Increased social isolation

We know that isolation – both with regard to care homes and people living in the community – can increase the risk of abuse happening and reduce the likelihood it will be reported and dealt with. Being detached from the outside world and from our family and friends, as well as being away from the places we usually visit, can be very unsettling. Although restrictions are now easing, people may still feel the effects of the isolation experienced over the last year or may not yet feel ready to mix more.

Some support services, such as day services or lunch clubs, may still have to close at times to protect people from transmission of the virus. These service disruptions may cause the person to be confused due to changes in routine and to be more socially isolated with fewer daily contacts. The lack of structure and meaningful activity may cause confusion and distress.

Try to ensure that the person you are supporting is able to maintain social contacts as much as possible, in whatever way they feel comfortable with. This may include continuing to use technology or meeting outdoors, or through a window at times when isolation is again required.

Stress on carers and caring relationships

There may be additional pressures on carers or family members when supports such as day services, respite services and lunch clubs have to close. Carers and family members may find themselves having to spend longer periods providing support without adequate breaks and assistance. This can cause stress and tensions that put additional strain on the caring relationship.

It is important that carers take care of themselves. You can help by making sure that they are aware that support is available.

If you notice someone is struggling you should make sure they know they can ask for help from the local authority. If you think that the carer is not coping and this may cause a risk of abuse or neglect, you should report it to your line manager in line with your safeguarding policy and procedures.

Overstretched and stressed care staff

The implications of COVID-19 on the care sector have been well publicised in the media. Staff continue to face significant pressures, particularly when colleagues need to isolate or become unwell, and it is important to ensure they remain supported by employers. Staff wellbeing is important in order to maintain good quality, safe services. Staff should receive:

  • adequate and appropriate personal protective equipment based on risk assessment. See current guidance on PPE
  • adequate supervision and support
  • appropriate COVID-19 training
  • support on end of life care, death and bereavement.

Some members of staff may be at increased risk of serious illness from COVID-19. Guidance has been issued to support employers to assess and reduce these risks.

An increase in criminal behaviour (scams etc)

The pandemic has been seen as an opportunity by some criminals to exploit people with dementia. Financial scams have increased and there has been a noted increase in scams relating to the pandemic, for example, masks ordered online that never arrive, or the offer of false cures. As a frontline worker you are the eyes and ears that may be the first person to pick up any signs of abuse. Here is a checklist of things you can do:

  • Talk to your residents or clients about the increased risk of abuse at this time.
  • Be aware that any changes in behaviour or demeanour could indicate abuse.
  • Advise people not to answer the door to strangers – and be aware of fake ID.
  • Try not to alarm people but ask them to be wary of offers to help, particularly from strangers.
  • Advise people to check with family, friends or paid support that offers of support, advice and help are legitimate.
  • Warn people against responding to any text, email or phone call from an unidentified source. Explain that fraudsters will imitate official bodies such as the Government or the NHS – and they do it very well!
  • Advise people that they should never give their personal data, passwords or pin numbers to anyone. Official financial bodies and other organisations will never ask for them.

An increase in domestic abuse

The COVID-19 crisis has caused many people to spend a lot more time with those in their household. In some cases this has caused additional tensions that spill over into abuse and violence. Evidence from statutory and voluntary agencies across the UK highlights an increase in reports of domestic abuse, with Refuge reporting a 60 per cent increase in calls and online requests between April 2020 and February 2021. The increase is thought to be related to forced coexistence, economic stress, and fears about the virus. In the case of people with dementia being cared for by family at home it may be due to the carer not coping with limited services, increased caring responsibilities and fewer breaks.

Those who are living with an abusive partner or family member may be less likely to ask for help during the pandemic as they may not want to bother overstretched emergency services. Fewer visitors to the household may mean that evidence of physical abuse goes unnoticed.

Domestic abuse is not just about physical violence. It can include other types of abuse such as emotional or psychological, sexual, financial and neglect. Domestic abuse can be experienced by both men and women.

If someone is in immediate danger you should call the police. If you have any concerns that abuse is happening to a person with dementia you should report it in line with your organisation’s safeguarding policy.

See Domestic violence and abuse: Safeguarding during the COVID-19 crisis.

Find out more

For more information, see our safeguarding resource hub.

Support from SCIE

SCIE's COVID-19 hub contains relevant information including dementia in care homes, safeguarding, Mental Capacity Act and infection control. It can be used when working and supporting people through COVID-19, and can also be shared with community groups.