Watch out for signs of care home abuse like weight loss, warns NICE guidance

Care home staff and relatives are being urged to identify and stop abuse and neglect in care homes by following new draft guidance published by the National Institute for Health and Care Excellence (NICE).

The guidance published on 3 September, covers what abuse and neglect looks like, advice on mandatory training for staff, how to recognise warning signs such as weight loss, and what actions to take when abuse or neglect is suspected.

It also calls on care practitioners to share information about what abuse and neglect may look like to residents, their families and care staff.

‘Empower’ relatives and care staff to protect residents

A consultation on the draft recommendations is now open, with individuals able to submit their views on the guidance.

NICE’s chief executive Gillian Leng said: “Every day, thousands of adults in care homes rely on the support and care of those around them; a fact that should never be taken for granted.

"This is an opportunity to equip residents, relatives and care professionals with the tools they need to identify neglect and abuse, and empower them with the knowledge of where they can go for help.

“It is our hope that by providing clear guidelines on the steps visitors, staff and organisations can take, we will all be better prepared to protect these residents in their time of need.”

Consider an external whistleblowing service

The guidance warns ‘Care homes and care home providers should have a whistleblowing policy and procedure, and make sure that staff are aware of these. Care home providers should consider using an external whistleblowing service (for example through arrangements with another provider).

‘If they do, they should make sure that staff know how to contact the service. Be aware that whistleblowers (including residents) are protected by law. Care homes and care home providers must ensure that whistleblowers are not victimised as a result of reporting or disclosing a safeguarding 18 concern’.

The guidance also states ‘all care home job descriptions (including at board level) should set out the safeguarding responsibilities included as part of that role’.

5.2% rise in abuse and neglect concerns

Abuse can come in different forms including physical, sexual, psychological, discriminatory or financial.

In 2018/19, 415,050 safeguarding concerns of abuse and neglect of adults were raised in England. This is a rise of 5.2 per cent on the previous year, according to NHS Digital figures.

The new guideline differentiates between residents’ physical and emotional behaviours that are ‘possible’ signs of abuse or neglect, which should make people look carefully at a situation, and ‘stronger’ signals that should lead people to suspect abuse and take immediate action.

Recommendations include that a staff member or visitor should ‘consider’ abuse or neglect in situations where there may be another possible explanation for a resident’s physical or emotional state.

It says care staff, families and residents should look at these signs and make judgements based on what they know about how each person usually behaves.

For instance, while there can be similarities between behaviours that are a reaction to abuse or neglect and behaviours linked with dementia, autism, learning disability or acute mental distress, ‘the possibility of abuse or neglect should always be considered as a cause of unexplained behavioural and emotional changes’.

When someone should consider abuse - examples include if a resident:

• has lost or gained weight unintentionally.

• uncharacteristically refuses or is reluctant to socially interact.

• does not have opportunities to do activities that are meaningful to them.

Circumstances are also described where people should ‘suspect’ abuse or neglect, where there is no clear alternate explanation. However, the guidance warns this should not be seen as absolute proof of abuse, but means immediate action is needed.

These include when a care home resident:

• lives in a dirty, unhygienic or smelly environment.

• is malnourished or dehydrated.

• is denied independence aids (such as hearing aids, glasses or dentures), contrary to their care and support plan.

Individuals can submit their views on the draft NICE guidance by the 1 October deadline.