Commissioning care homes: common safeguarding challenges

Common safeguarding issues – Physical abuse between residents

Care homes often have to deal with altercations and abuse between residents, some of which entail physical attacks. This could be the result of tensions between people living in close proximity, and may also be caused or exacerbated by misunderstandings due to dementia, learning disability, or mental health problems. Some instances of challenging behaviour may be due to poor relationships with, and poor management of, residents. Training in managing challenging behaviour, appropriate restraint and de-escalating situations is important.

Prior to someone choosing a home, their assessment should consider their compatibility with other residents and any risks to the individual or other residents due to challenging behaviour. In order to reduce or avoid abuse and harm, care homes should work to prevent such incidents occurring by identifying triggers and supporting individuals who perpetrate abuse as well as their victims.

Prevention checklist

• All residents are assessed in terms of their risk of being abused or of abusing others.
• Physical screening takes place to rule out infections which could alter behaviour.
• Staff are trained to identify the causes of challenging behaviour and understand that it may be used as a method of communication.
• Where risks are identified, plans are in place to support individuals and to prevent and reduce the risk of abuse.
• Care home staff are trained and competent in the management of challenging behaviour and supported by community health care professionals.
• Medication is reviewed regularly, whenever behaviour changes and at least every six months.
• Investigations are carried out to assess for medical or other reasons which may be causing behaviour that is difficult to manage.
• Where there are ongoing issues between individuals, the care home takes a multi-agency approach to long-term resolution.
• All incidents of abuse between residents are recorded and reported under local safeguarding procedures. Close family or friends should be informed unless there is a legitimate reason for not doing so.

Resources

• SCIE At a Glance 37: Challenging behaviour: a guide for family carers on getting the right support for adults
• SCIE Dementia Gateway: Aggressive behaviour
• SCIE e-learning course: Managing risk, minimising restraint: Challenges, dilemmas and positive approaches for working with older people in care homes
• SCIE resources on Minimising the use of restraint in care homes
• The Challenging Behaviour Foundation