Commissioning care homes: common safeguarding challenges

Common safeguarding issues – Rough treatment, being rushed, shouted at or ignored

The research underpinning the SCIE Dignity in care guide highlighted that people receiving care support often feel they are being roughly treated, rushed or ignored. People can experience such treatment as abuse. Unexplained bruising is a common reason for safeguarding referrals and rough handling may often be the cause. Care workers should be mindful that the people they are caring for may be in pain due to illness or disability and may bruise easily due to physically frailty. People with dementia, learning disabilities or mental health problems could be fearful of physical intervention due to lack of understanding of what is happening to them.

Shouting, raised voices or the tone used may also cause distress and harm to people and they may experience such interactions as intimidating. This can occur when people make assumptions about the person's inability to hear or understand, it can be due to cultural difference where a worker may naturally converse more loudly than the care recipient, or it could be a result of the care worker being busy and stressed due to inadequate staffing levels. Tone is important: people should be addressed in a respectful manner and not in a way that is sharp, abrupt or condescending.

It is very important that the home demonstrates a 'zero tolerance' approach to insensitive care and that residents are encouraged to comment on their experience of receiving care so that such matters can be addressed.

Prevention checklist

• The home actively promotes Dignity in care and has a zero tolerance approach to insensitive care.
• The home has adequate staffing levels so that staff are not forced to rush or ignore requests from residents.
• Staff are trained and competent in manual handling techniques and the use of mobility aids.
• Care provision is personalised and tailored to individual needs.
• Residents' individual communication needs are recorded on their care plan and staff are trained in how to communicate with people with particular difficulties.
• Care plans identify those most at risk of being subjected to abuse (this includes people who are quiet or isolated, unable to communicate well and those who are demanding or considered difficult to work with).
• Residents are never denied access to staff call buttons and alarm cords.
• The home regularly seeks feedback from residents and relatives on the quality of care provided.
• Problems arising from cultural differences between staff and residents are identified and addressed through training and supervision.
• Staff are encouraged to identify and challenge inappropriate care by their peers.
• The home has a whistleblowing policy, which includes the option of alerting externally through the local authority, and staff are aware of their individual responsibility to raise concerns.

Resources

• SCIE Dignity in care guide
• The My Home Life movement offers a range of resources to improve the quality of life of older care home residents.
• Public Concern at Work advice and support on whistleblowing