This essay will discuss the older adult whose illness referred them to palliative care and onto safeguarding. I will first explain what safeguarding a vulnerable adult on palliative care is and explain my scenario and discuss what had happened and what could have helped the patient who was at the end of life care. The Department of Health, (2011) defines Safeguarding as a multi-disciplinary work that works together to minimise and manage risks to vulnerable adults. A framework is put in place which brings all aspects of investigation into an allegation of abuse or neglect against a vulnerable adult. A vulnerable older adult is someone who may be in need of community services due to age, illness, mental or physical disability who is also unable to take care of themselves against significant harm or exploitation. (US Department of Health, 2012) The patient I will be talking about is a 94year old lady and all names will be changed in accordance with the NMC, (2008) code of conduct.
Whilst on placement, working as a Community Nurse, I spent a day with the Palliative Care Specialist Nurse. I understood that palliative care requires an active holistic care of patients who are in the advanced stages of a progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of illness in conjunction with other treatments. Whilst out in the community I came across a patient that had been referred to the district nurses, after having a referral by palliative care for end-stage renal failure; this is when the excretory functions of the kidneys are lost, acid-base balance cannot be maintained and the endocrine functions of the kidney are disrupted. (Ross and Wilson, 2010)
The patients’ main carer was her son, who had discharged the patient from hospital and had refused to give the patient medication which the general practitioner (GP) had prescribed. The patient did not speak English and therefore a language barrier existed, but communication would be via the carer. According to the Local Government Association guide for Adult Safeguarding and domestic abuse, (Local Government Association, 2013) Local Government Association, (2013) state there is under-reporting of domestic abuse by people from Black and minority ethnic (BME) communities in the general population, therefore go on to state that some of the additional barriers to reporting faced by them could be: language barriers or family honour, shame and stigma. A full assessment was carried out and I was surprised when I noticed that the client was lying on black bin liners to protect bedding as she was doubly incontinent. I also observed that the patient had oedematodes on their right arm and discoloured skin marks on the left arm and legs. The patients’ carer reported that the patients’ skin was always like this.
After the assessment, a care plan was set in place for the patient with advice given to the carer. The main carer refused to have any sort of input from social services for package of care (POC) and stated clearly to us that he was able to be the full time carer. Advice given to the carer about getting the patient a hospital bed and mattress and other equipment but the carer declined any type of help. I don’t know whether this was due to the patient being unable to cope with the patients deuterating condition and was unwilling to accept help when he needed it. The charity Action on Elder Abuse defines abuse as 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. (Age UK, 2013) On the next visit, the carer still refused any help from the outside community team. I observed that the patient was uncomfortable and had developed itchy skin; a letter was sent off to the GP for some antihistamine tablets and emollient cream.
The next visit I went with a member of staff and the carer still disagreed with accepting help so the Palliative Care Specialist Nurse and social workers were informed to get an assessment done of the vulnerable older lady. This follows guidance stated on the NHS Choices website page for safeguarding vulnerable adults. After staying in the home while the staff member called up other professionals, the man finally agreed to have social workers involved. This was then done as a fast track for the patient to have POC 3 times daily. Sadly, this was most likely too late and the patient passed away the same evening. Looking back on this scenario I found that it’s very difficult when tackling neglect of a vulnerable older adult, who was unable to express her own wishes to members of the team due to the language barrier. I do feel that this was a sign of neglect, but abuse can be accidental and I feel in this case it was most likely.
The reason for this is the carer had tried to care for the patient the best way he could but found it very hard and may have gone into denial thinking he could manage all on his own and couldn’t accept help from the multidisciplinary team. The nature of the abuse is not always visible but some common signs are, for instance the bedding and inappropriate clothing. Some older adults are less able to protect themselves when they are at the end of life care, and do rely upon people around them, however there are cases where intervention’s from members of the community care should of been brought in, like the social services due to illness; an earlier intravenation could of helped the patient to be more comfortable, but that is my own feelings on this matter. (Office of the Public Guardian, 2013) Safeguarding provides a structural framework to protect vulnerable persons against abuse and neglect, whether intentional or unintentional and it is therefore important for the patient, that the multi-agency works together, whereby each individual is aware of the patient, and the appropriate systems are in place to alert any concerns.
Age UK (2013) Factsheet 78: Safeguarding older people from abuse [online]. Age UK. Available from: http://www.ageuk.org.uk/Documents/EN-GB/Factsheets/FS78_Safeguarding_older_people_from_abuse_fcs.pdf?dtrk=true [Accessed: 3 April 2014]. Department of Health (2011) Department of Health, Safeguarding Vulnerable Adults [PDF]. Department of Health. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215591/dh_126770.pdf [Accessed: 18 March 2014]. Local Government Association (2013) Adult safeguarding and domestic abuse: A guide to support practitioners and managers [online]. Directors of adult socail services. Available from: http://www.local.gov.uk/c/document_library/get_file?uuid=5928377b-8eb3-4518-84ac-61ea6e19a026&groupId=10180 [Accessed: 3 April 2014]. NMC (2008) The Code of Conduct in full [online]. Nursing and Midwifery Council. Available from: http://www.nmc-uk.org/Nurses-and-midwives/Standards-and-guidance1/The-code/The-code-in-full/#dignity [Accessed: 23 March 2014]. Office of the Public