Responding to Allegations of Elder Abuse

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Responding to Allegations of Elder Abuse

• Sarah Marsh Dedicated Officer Elder Abuse HSE
  Dublin Mid-Leinster
• October 2009

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Background

• Protecting Our Future
• a clear policy on elder abuse is formulated and
  implemented at all levels of governance within
  the health social and protection services in
  Ireland.
• 2005 HSE Implementation group
• Drafted this policy general principles for
  responding managing allegation.
• 2008-HSE Launch Policy in Galway

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Policy Statement

• HSE committed-
• to protection of older people
• protection promotion of rights of older people
• All HSE staff duty of care to intervene
• Managers duty to ensure local procedures
  developed
• LHO ensure systems in place for public to report
  concerns

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Underlying Principles

• empowerment
• rights of the individual
• recognise people who are unable to make their own
  decisions
• self determination can involve risk
• least restrictive alternative
• protection of the law
• access to judicial process

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Policy

• Each HSE area to develop and implement an Elder
  Abuse (EA) Policy
• Establish Regional Steering Committee
  (multidisciplinary, representative of statutory
  voluntary agencies)
• Procedures raising concerns, referrals,
  reporting
• Feedback system (monitoring referrals)
• Awareness raising and training

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Definition

• A single or repeated act or lack of appropriate
  action occurring within any relationship where
  there is an expectation of trust which causes
  harm or distress to an older person or violates
  their human and civil rights.
• Applies to 65 years over
• Includes inadequacies of care or inappropriate
  programmes of care
• Excludes
• Self Neglect
• Crime by strangers
• However..
• These procedures may be followed where it is in
  best interest of older person e.g. extreme self
  neglect

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ProceduresSelf Neglect Anonymous Allegations

• Self Neglect
• Policy may be followed in circumstances where the
  concern has arisen due to older person seriously
  neglecting their own care and welfare and putting
  themselves or others at serious risk.
• Anonymous Allegations
• Should be treated seriously
• Investigations my be limited and referrers should
  be advised accordingly
• Allegations concerning HSE staff/facilities
  should be recorded investigated through the HSE
  complaints procedure.

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Categories of Elder Abuse

• Physical abuse
• Sexual abuse
• Psychological abuse
• Financial or material abuse
• Neglect and acts of omission
• Discriminatory abuse

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Roles responsibilitiesLine managers

• Develop local procedures
• Ensure staff aware of procedures
• Receive reports
• Ensure documentation is completed
• Ensure resources allocated investigation
• In complex cases inform other relevant managers
• Ensure staff attendance at training
• Liaise with other agencies including An Garda
  Síochána

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Roles responsibilitiesAll HSE Staff

• Be aware of local procedures ensure allegations
  are responded to
• Noting and recording allegations
• Informing line manager
• Sharing info
• Take part multidisciplinary meetings
• Adhere to care plan
• Seek/attend training

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ProceduresReporting a concern

• All reports to be taken seriously
• All health care workers responsibility to inform
  their line manager
• If older person at immediate serious risk
  Gardaí
• Establish views wishes of older person
• If inhibited from reporting matter to line manger
  OR feels manager took inappropriate/insufficient
  action report to more senior management.

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Reporting allegations of Elder Abuse flow diagram
Notify Gardai if immediate and serious risk
Health Care Worker Suspects Abuse
Notify high-risk cases to General Manager /
Administrator

Notify Line Manager
Notify Gardai, where Appropriate

Notify / refer to Senior Case Worker
Following meetings may be held Case
Discussion Case Conference Family Meeting
Assessment
Care Plan
Review
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ProceduresLine Manager

• On receiving report
• Establish if older person is at immediate and
  serious risk
• Ensure protective measures
• ? Gardaí
• Where other HSE services/staff involved discuss
  and agree who to take lead
• Consider informing child care manager /
  disability services

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Working Group on Elder Abuse

• Protecting Our Future recommendations
• Policy - HSE Elder Abuse Policy to be developed
• Staff Structure Regional steering committee
• Procedures to be developed for reporting and
  responding to elder abuse allegations
• Prevention awareness raising and training
  programmes

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Staff Structure

• Team Steering Committee, Dedicated Officer
• EA, Senior Case Worker EA.
• Devise and oversee policy on EA
• Create awareness of EA among staff
• Promote training for all staff dealing with older
  people
• Guide development of policy and best practice for
  prevention
• Develop procedures and guidelines for responding
  to EA

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ProceduresSenior Case Worker

• Responsible for investigation and management of
  incidents
• Recording assessing, managing and coordinating
  response
• Advice guidance to those raising concerns
• Referring services continues to be involved

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Senior Case Worker EA

• Manage and coordinate the response to allegations
  of EA
• Carry out, assist or advise in the investigation
  of concerns / alleged abuse
• Liaise with Nursing Home Inspection Team in its
  investigation of complaints where appropriate
• Act as a resource to health professionals
  regarding identification and management of EA
• Participate in design development of awareness
  raising and training programmes

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Dedicated Officer EA

• Oversee implementation of EA policy
• Ensure Regional Steering Committee in place
• Develop processes for reporting and responding
• Design awareness raising programmes
• Design and deliver training programmes
• Provide support to other agencies in developing
  EA policies and procedures
• Analyse data and trends for service planning

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Procedures outside HSE

• Nursing homes
• allegations of poor care standards should be
  reported to HIQA
• Other Org (vol day care, meals on wheels etc)
• HSE should inform manager of organisation and
  provide written report. HSE Mgr make arrangements
  to monitor organisations' response. HSE may
  conduct own investigation

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Other relevant policies - procedures

• Complaints procedure
• Incident reporting
• Working with An Garda Síochána
• Refusing assistance /protection measures
• Legal protections -older person
• Record keeping
• Confidentiality

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Thank You!

• If I can be of further assistance please email me
  at sarah.marsh_at_hse.ie