D356. Safeguarding People Who Are Experiencing Self-neglect and Hoarding
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Safeguarding People Who Are Experiencing Self-neglect and Hoarding (Domiciliary Care, England) Policy
Policy Statement
This policy describes the safeguarding arrangements made by {{org_field_name}} when they encounter people who are neglecting themselves in the basic activities of daily living and who are at risk of harm, and who might also cause harm to other people as a result. The policy is supplementary to the main Safeguarding People Using a Care Service from Abuse or Harm in Care Homes (England) Overarching Policy and applies where additional safeguards might be needed to protect people receiving care who are experiencing self-neglect, which could also include engaging in hoarding behaviour.
The policy is written to reflect the duties of a Local Authority under the Care Act 2014 for assessing the needs for care and support and for taking appropriate action to meet any identified needs of people who are experiencing self-neglect to the point where their health and wellbeing is put at risk or has been significantly compromised from the neglect.
{{org_field_name}} accordingly follows the Care Act 2014 definition of self-neglect: “a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding” .
It also recognises that self neglect can be difficult to define and to know the reasons for it and how it can be made better.
As stated in the Care Act statutory guidance (14.17), “This (self neglect) covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. It should be noted that self-neglect may not prompt a section 42 enquiry. An assessment should be made on a case by case basis. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.”
Scope of Policy
As a care service to people in their own homes we think that our policy should extend to the following.
- Where we become aware of someone receiving our care is experiencing self-neglect, which could include hoarding behaviour, and who is at risk of harm as a result. In these instances we ensure that we follow the safeguarding procedures set out in our main safeguarding policy.
- Where we are asked to provide a service to someone who has care and support needs arising from their self-neglect and who has agreed to receive our help. In these instances we recognise that we would most likely be working as part of a multi-agency effort to help the person develop or recover their self-caring abilities to an agreed level.
- We become aware of someone in the community in which we provide services who is experiencing self-neglect and who is at risk of harm as a result, and for whom we should exercise our duty of care by reporting to or alerting the local authority safeguarding service to the situation as any other responsible citizen.
Our Understanding of Self-neglect
{{org_field_name}} recognises that self-neglect is hard to define from any standpoint, not least one that results in official intervention that risks breaching a person’s human rights to live their life as they choose without interference. It also recognises its duty of care to ensure that people are kept safe from harm and from harming others.
In any case of suspected self-neglect {{org_field_name}} will ensure that the situation has not arisen from acts of neglect and omission, which are also forms of abuse resulting in possible harm, which also require safeguarding action.
{{org_field_name}} recognises that self-neglect will usually be identified in people who live in their own homes often alone, though sometimes with a partner and sometimes where both or all household members are experiencing levels of self-neglect.
{{org_field_name}} accepts that people can neglect their own care and wellbeing because of mental ill health, particularly depression, lack of motivation or a will to live, social isolation and many other reasons.
{{org_field_name}} realises that people who neglect themselves are often very difficult to help, particularly where they appear to be doing this consciously and lack of mental incapacity cannot be easily proved. They might become receptive to help, including medical help, only by developing some understanding of the issues that underlie their behaviour, which requires sensitive and skilled professional help.
{{org_field_name}}’s Expectations of its Staff
We will train and expect our staff to be aware of and alert to in the course of their work to the following signs of self-neglect, which are similar to those of neglect and acts of omission by third parties, but are self-driven. They include:
- living in dirty or insanitary conditions presenting personal and environmental health hazards
- refusing to eat or drink properly, failure to obtain adequate food and drink, possible malnourishment, and lack of self-regard generally
- poor personal hygiene, inappropriate dress, wearing soiled or dirty clothes and illness caused by the neglect
- hoarding with clutter that results in difficulties in moving around the place of residence, using its utilities safely, and freely carrying out normal self-caring activities such as eating, drinking, sleeping, washing and bathing, using a toilet and laundry and which could result in environmental health and infectious disease risks
- social withdrawal and disengagement, staying in bed and just wanting to be left alone, refusing to see visitors or have social contacts
- abusive, aggressive and antisocial behaviour towards anyone considered as interfering or intrusive
- inconsistent or reluctant contact with external health and social care organisations
- being at high risk from everyday hazards or dangerous situations
- repeated failure to receive or take prescribed medication, repeated failures to be given or take medication correctly (for example the dose, timing, method or type of medication)
- denial of any need for communication or independence aids (such as hearing aids, glasses or dentures), contrary to a care and support plan.
Procedures
{{org_field_name}} does not consider any of the above to be on their own sufficient evidence of self-neglect requiring intervention, It does expect its staff to be sufficiently alert to the possibility when they find one or more serious indications, and should therefore act in line with their duty of care to that person by reporting their concerns initially to their manager who can make further enquiries and initiate further action in line with their assessment.
Where there is evidence that a person is being harmed or is at risk of harm because of their self-neglect, {{org_field_name}} will discuss or refer the matter to their social worker if there is one, or to any other professional with a similar duty of care or to the local safeguarding team so that it can decide if the situation meets the threshold for a Section 42 enquiry.
In processing the concerns that have been raised by the situation, {{org_field_name}} is mindful of the need to obtain the person’s consent in any action it takes or to ensure it is acting in a person’s best interests if the person does not have the mental capacity to give their consent.
It is also mindful of the need to keep the person fully informed and involved in all the actions it takes in line with Making Safeguarding Personal principles.
{{org_field_name}} will follow its safeguarding procedures for record keeping, inter and multi-agency co-operation, particularly with the local safeguarding adults team, and for reviewing situations in respect of the people using its service who are experiencing self-neglect.
Risk Assessment
{{org_field_name}} always carries out risk assessments as part of its duty of care to keep its staff safe under health and safety laws. It will always reassess risks in situations where self-neglect could be increasing risks of infection illnesses and/or environmental impact. It will co-operate with any other agencies, such as fire service or environmental health in their risk assessments and follow all agreed risk control measures.
Training
{{org_field_name}} will ensure that recognising and reporting on the signs and indications of self-neglect and hoarding behaviour is included in its safeguarding training, and is regularly updated and refreshed.
Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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