How to handle difficult relatives of elderly residents following new guidance from CQCNovember 10, 2016
In early November 2016, the BBC’s Victoria Derbyshire programme highlighted instances where relatives were banned from visiting elderly residents after making complaints about their care. In some cases, complaints even resulted in the residents being evicted.
CQC responds with new guidance following BBC documentary
In response to the concerns raised in this programme, the CQC has issued guidance for care homes and family and friends which can be found here.
The new guidance indicates that the CQC will:
“…..explore how we can collect information to give us a greater insight into this issue which we know worries the public and can be an important indicator of a service struggling to provide good care…”
This guidance suggests that during inspections, CQC will start scrutinising incidents where restrictions are placed on relatives visiting the care home and where placements are terminated following complaints about the quality of care.
When relatives and friends are causing genuine issues
We often help providers manage concerns about the behaviour of relatives. Providers do not generally wish to bar any visitors from seeing service users but some relatives and friends can cause serious issues for service users and staff.
It is unfortunate that all providers in the sector have to deal with the ramifications of negative media scrutiny, which tends not to fully explore the subtleties of an issue such as this. However, providers must manage these situations, and our advice is to consider all the ramifications before you act.
CQC’s new guidance
1. Providers must act to protect service users’ human rights:
“If a service that is fully or partly funded by the local authority or NHS stops a resident from receiving visitors, this may be a breach of the resident’s rights under Article 8 of the European Convention on Human Rights… (this is everyone’s right to respect for their private and family life, home and correspondence)"
However, visitors can be restricted if they themselves pose a risk:
Importantly, rights under Article 8 are not absolute – they need to be balanced against other rights and the rights of other people. This means there may be a small number of very specific circumstances where care providers can restrict, or even refuse visitors.” (CQC)
2. CQC warns providers against potential breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, such as:
- Regulation 9 (person-centred care)
- Regulation 10 (dignity and respect)
- Regulation 11 (need for consent)
- Regulation13 (safeguarding service users from abuse and improper treatment)
- Regulation 16 (receiving and acting on complaint).
- What to do if a visitor(s) poses a risk?
We expect more scrutiny during inspections of complaints handling and any situation involving restrictions on or barring of relatives from visiting a service user. If such a situation arises, ensure that your documentation is very thorough. Providers should also ensure that they have proper complaints handling procedures in place and that all complaints are thoroughly considered and documented.
As a starting point, CQC suggests talking to the visitor in the first instance as they may not realise they are posing a risk. It seems obvious to us that most providers would do this as a matter of course. If you find that restrictions need to be placed on relatives, we suggest that you also communicate these in writing to the relative. We can provide support by writing to the relative in question to make the position very clear. This may help diffuse the situation and reduce the risks of direct confrontation during visits.
You should also keep very good records of the reasons the restrictions are necessary, for example, for the safety or well-being of the service user or the safety of staff and other residents. CQC’s guidance suggests that if relatives or visitors pose a real issue, providers should report their concerns to the local authority safeguarding authorities - we think this is a very sensible suggestion.
CQC’s guidance also gives the helpful suggestion that:
“Any conditions should be proportionate to the risks to other people or staff and kept under review. The provider must be able to demonstrate that any conditions are not a response to the visitor raising concerns about the service as this would be a breach of the regulations. The provider should seek advice from the local authority’s Deprivation of Liberties team if the resident lacks capacity to make decisions.”
It should be a rare thing to have to terminate a resident’s placement because of disruption caused by relatives, but if this becomes necessary, the decision should be made by senior management and the reasons properly documented and explained to the relatives and the local authority. Care must also be taken to give the correct and sufficient notice under the terms of the contract.