Commissioning care homes: common safeguarding challenges
Common safeguarding issues – Institutionalised care
'Institutional abuse occurs when the routines, systems and regimes of an institution result in poor or inadequate standards of care and poor practice which affects the whole setting and denies, restricts or curtails the dignity, privacy, choice, independence or fulfilment of adults at risk’ (SCIE 2010). For example, people being forced to eat or go to bed at a particular time can be experienced as abuse. The culture of the organisation may promote institutionalised care and may cause 'the practices of well-intentioned staff to deteriorate’. It may also allow intentional abuse to go unreported (Marsland et al. 2007).
Care homes should promote a personalised service through flexibility and avoid strict routines. Staffing rotas should be focused around residents’ individual needs and preferences.
- The home demonstrates good management practice and strong leadership.
- All residents have their needs and preferences recorded on their care plan and staffing is arranged to accommodate this. Where best interests decisions need to be made because of lack of capacity, the person is still involved in addition to family or friends who can represent them.
- Residents are involved in any decision that affects their care, including personal decisions (such as what to eat, what to wear and what time to go to bed), and wider decisions about the service (such as menu planning or recruiting new staff).
- Those who need support with decision-making due to cognitive impairment receive the help and advice they need and have access to advocacy.
- Staff are trained and competent in communicating with people with communication difficulties or cognitive impairment.
- Residents are supported to pursue activities and interests of their choice and this is not restricted by staff shift patterns (e.g. if a resident wishes to go out in the evening they can return at a time of their choice).
- Night staff are available to support residents and not restricted in doing so by task-centred work.
- Visits from family and friends are encouraged and not restricted to certain times. Their involvement in decisions and the running of the home is encouraged.