Intimate Personal Care Policy Document Type Author Owner (Dept) Intimate Personal Care Policy Chief Executive Services and Development Issue Date March 2014 Date of Review April 2015 Version 2 Page 1 of 7
1 Purpose and Scope The purpose of this policy is to set out the standards, which must be adhered to when providing intimate personal care to service users. Through this policy staff will be able to offer a service and approach, which acknowledges their responsibilities and protect the rights of everyone involved. This policy will enable the service to comply with; The Adults with Incapacity (Scotland) Act 2000, and Human Rights Act 2000. It gives specific guidance regarding adults at risk, and those whose first language is not English. This policy also adheres to the human rights principles found in the Mental Health (Care and Treatment) (Scotland) Act 2003. 2 Statement Policy The Mungo Foundation attaches the highest importance to ensuring a culture that values the privacy and dignity of service users who are cared for by us. Staff have a professional duty of care, and have responsibilities to act in the individual s best interest and are accountable for their actions. Staff must be sensitive to differing expectations associated with race, ethnicity, age, gender, disability, religion/faith, and sexual orientation. Intimate and personal care is one of the most basic and fundamental human needs. It involves activities such as bathing, toileting, washing, cleaning teeth and shaving- in some of our services it may also include administration of rectal medication and topical application of creams to intimate parts of the body. Most people take for granted their ability to carry out these tasks in private, and may not have considered the influence they have on their quality of life. But some groups depend on others to carry out intimate and personal care, and may have to expose and be touched on private parts of their body. The way in which care is delivered can significantly affect quality of life (Mirfin-Veitch et al, 2004). Many people with complex needs, frailty of old age, learning disabilities, dementia and physical disability experience either urinary or faecal incontinence or both which has a significant impact on the intimate care needs of people. Page 2 of 7
3 Aims and Method The policy applies to the care of service users who require support of an intimate nature, including bathing, intimate hygiene and intimate intervention and treatments. Intimate and personal care is an important area of an individual s self image and respect. The apparent nature of many care interventions, if not practiced in a sensitive and respectful manner, can lead to misinterpretation and occasionally allegations of abuse. Not understanding an individual s specific needs can lead to confusion and misunderstanding. It is therefore important that social care workers are sensitive to these issues and aware of the potential for individuals within at risk groups to become the victims of abuse. A relationship of trust is required to ensure that all service users receive the same degree of care and support, (Adults with Incapacity (Scotland) Act, 2000). A relationship of trust can be described as one in which one party is in a position of power or influence over the other by virtue of their work or the nature of their activity. Relationships developed by professions such as nursing and allied professionals (including social care workers), are all founded on trust (Home Office, 1999). The Adult Support & Protection (Scotland) Bill as passed is intended to give greater protection to adults at risk of abuse. This includes those who are mentally unwell. The new Bill gives new powers and a statutory responsibility to local agencies to investigate any risk of harm or abuse to adults living in care homes or in the community. Part 1 of the Bill is concerned with adult protection. Multiagency protocols are in place in all areas in which The Mungo Foundation operate that guide and inform local inter-agency procedures & practice concerning the protection of vulnerable adults 4 Definitions What is Intimate Care? Intimate care covers all areas of personal care that most individuals learn to carry out independently as they grow and develop, but some are unable to do so because of impairment or disability, age, understanding/ communication difficulties. Individuals may require help with eating and drinking, washing and dressing, toileting and intimate hygiene. Help may also be required to change stoma bags, manage urinary catheters or administer rectal medication (Scottish Executive, 1999). Other procedures such as intimate examinations undertaken whilst an individual is in hospital also require the same degree of respect. Page 3 of 7
5 What is a Chaperone? An individual who acts as an advocate for the service user during examination, intimate care, providing explanation and reassuring the service user whilst safeguarding against unnecessary discomfort, pain, humiliation or intimidation (Royal College of Nursing, 2002). 6 At Risk Groups All individuals dependent on others for care are vulnerable. Factors, which increase this vulnerability, may include: Reduced control over their lives or decisions due to their disability or lack of understanding; Reduced communication skills to let someone know they are not happy; Multiple carers due to hospital admissions or respite/residential care; Discrimination against children and adult with disabilities in society; Individuals whose first language is not English; Individuals suffering from a mental illness including people with dementia (Scottish Executive, 1999; Scottish Executive, 2000). Intimate personal care involves risks for both the service user and the staff providing the care as it may involve the touching of intimate parts of the body. By acknowledging the issue and understanding the principles of protection, choice and rights in relation to intimate care, the risk can be minimisedalthough not removed. To ensure staff protect the rights of everyone involved, all staff providing care within The Mungo Foundation must comply with the following principles for practice. 7 Responsibilities 7.1 Principles of Practice All staff must ensure that they promote and enable each individual to be part of the decision making process in relation to their intimate and personal care; giving all relevant information to ensure service user choice and informed consent has been obtained. In the event that the service user does not have the capacity to consent, The Adults with Incapacity (Scotland) Act 2000 provides a comprehensive framework to ensure equity of treatment and choice for adults with incapacity, and makes provision for decisions to be made on behalf of an adult, subject to safeguards and in specific and well-defined situations. Where staff are in any doubt re the wishes or consent of a service user, then advise must be sought from their line manager. Page 4 of 7
Incapacity is defined within that Act as being incapable of: acting, making decisions, communicating decisions, understanding decisions or retaining the memory of decisions, by reason of mental disorder or of inability to communicate because of physical disability. If required, an incapacity certificate must be completed prior to any intervention or treatment. Independence must still be promoted, and consideration given to additional needs, communication methods or tool that may be required. The following principles for good practice should assist in this matter: Allow the individual to care for him/herself as far as possible; Allow an individual wherever possible to express a preference for his/her carer; Where the individual is unable to give consent, discussions must take place with themselves, their carer or other legally appointed representative as to their preferences; Ensure the privacy and dignity of the individual; Be aware of and responsive to the individual s reactions; If carrying out intimate care away from the residential facility/individuals home, ensure the privacy and safety of the individual. All staff should be familiar with the following documents: The Age of Legal Capacity (Scotland) Act, 1991 Human Rights Act, The Home Office, 2000 Adults with Incapacity (Scotland) Act, 2000 Mental Health (Care & Treatment) (Scotland) Act 2003 The Adult Support & Protection (Scotland) Bill 7.2 Providing Intimate Care In the provision of social care, staff are in a position of trust and responsibility. This trust and responsibility is heightened when providing intimate care. It is neither practical nor possible to eliminate the fact that intimate care may be provided by a member of staff of the opposite gender. However, in order to safeguard individuals, The Mungo Foundation s best practice should be followed, which means that service users can routinely expect to receive intimate care by a member of staff of the same gender. On occasions where this is not possible, staff must take steps to ensure that the individual and/or their representative have provided consent. Where the situation demands that intimate care be given in an emergency situation, staff should seek advice from the senior Page 5 of 7
member of staff on duty and clearly record the details of the situation and who administered the care. Best Practice Guidance for Personal Care: If personal care is to be given by a member of the opposite sex, the individual s consent must be obtained; In situations where an individual requires care from more than 1 member of staff, the member of staff leading on the care should be of the same gender as the service user; During washing, toileting and dressing, staff should take steps to ensure that the service users body, especially intimate regions are not left exposed and should ensure that the person is covered with towels or clothing during administration of intimate care; If staff of same gender or a chaperone is not available and the individual has not consented to receiving care from someone of the opposite sex, and if the care is not urgent- this must be explained to the individual and/or their representative to ascertain if they would prefer to proceed without a chaperone, or offer to delay the care until such time as a chaperone is available; In services where intimate personal care may be given on occasion by members of the opposite sex, information must be given to service users in advance of such a situation potentially arising. Discussion and agreement should take place with the individual, their carer/ representative. This information must be recorded in the individual s care plan highlighting that consent has been obtained (or not); It is the responsibility of staff, through record keeping to monitor the frequency of same gender staff not being available for intimate personal care needs; Religious views of families must be taken into account. It may be the case that males can only have intimate care provided by another male, therefore involvement of the family in the care of the individual is important; Apart from in emergency situations, staff must get to know the service user before being involved in any intimate or personal care; Service users who require support with intimate care must have an up to date care plan that covers key aspects of care and highlights preferences, wishes and consent. Page 6 of 7
7 References - Adults with incapacity (Scotland) Act, The stationery Office, Edinburgh, 2000 - Caring for Young People and the Vulnerable, Home Office, 1999 - Children (Scotland) Act, HMSO, London, 1995 - Good Medical Practice Maintaining Boundaries, General Medical Council 2006 - SSSC Codes of Conduct - Guidelines for staff who provide intimate care for children and young people with disabilities, Scottish Executive 1999 - Human Rights Act, The Home Office, 2000 - Mental Health (Care and Treatment) (Scotland) Act 2003 - Spiritual Care: A Multi-Faith Resource for Healthcare Staff, NHS Education for Scotland 2007 - The Adult Support & protection (Scotland) Bill, Scottish Executive - The Age of Legal Capacity (Scotland) Act, HMSO, 1991 Page 7 of 7