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In the UK, it is a well-known fact that the population is ageing. Many more people are living for longer than in previous times in history. According to Methodist Homes (MHA), one of the largest charities for elderly care in the UK, there are over 15.5 million people aged 60 or over, which make up 23% of the total population in the UK.
When you look at those over 80, the number is also increasing, with 3.2 million people falling into this category. Additionally, almost 600,000 people in the UK are aged 90 or over.
By 2041, it is predicted that there will be more than 3 million people who are aged 85 or older, which is more than double today’s figure. The ONS also predicts that there are likely to be an additional 8.6 million people aged 65 and over in 50 years’ time. This is a staggering number and is a population roughly the size of London today. This is one of the reasons why aged care, and preparing for it in the future, has never been more important.
What is aged care?
As a person grows older, it is often more difficult for them to do things independently. An older person may have health or mobility problems or may need help around their home. Aged care encompasses all of this and is simply the support given to older people either in a nursing or residential home or support provided in their own home. Aged care is also known as elderly care.
It includes help with health care, personal care, everyday living, mobility aids, home adaptations and accommodation, as outlined below.
- Health care: Collecting prescriptions, physiotherapy, nursing or medical care.
- Personal care: Bathing, going to the toilet, dressing, eating and personal grooming.
- Everyday living: Shopping, housework, cooking and social visits.
- Home adaptations: Ramps, handrails and mobility aids.
- Accommodation: For those who need more intense care, where staying in their own home is no longer possible or appropriate.
Aged care helps a person to retain some independence and helps them to stay connected with friends and their local community. It also helps to meet social and cultural needs as well as take care of an elderly person’s health and safety.
Aged care should be person-centred. The Care Act 2014 established that person-centred care is now fundamental in social care laws and policies. By having care that is centred around the elderly person, it can reduce the person’s functional decline. It ensures that the older person’s needs are respected as well as their choices and preferences. This also can lead to a reduction in admissions to hospital and mortality rates as well as increased satisfaction from older people and their carers.
What is confidentiality in aged care?
Confidentiality comes down to the principles of respecting a person’s privacy and their wishes. In aged care, elderly patients should have privacy over the information that they provide to care workers as well as control over who sees the information. This means that unauthorised access to their information is prevented. Confidentiality in aged care plays a significant role in upholding an elderly person’s privacy.
Confidentiality also includes other factors such as legal requirements in addition to the elderly person’s and their family’s requirements, including their health records. Those providing aged care should uphold high standards when it comes to confidentiality. Transparency and being open with elderly patients and their family over how their personal information is used is paramount.
Health and social care professionals who are providing aged care (such as doctors, nurses, care workers, support workers and social workers) should therefore not share any personal information about someone in their care unless their patient has given permission or unless it is necessary.
This means that practitioners should not show anyone a person’s notes or records unless they need to know, and they should also not recount what a person has said unless necessary for their role or the elderly person’s wellbeing.
What is privacy in aged care?
Privacy with information is an important factor in the provision of aged care and follows the same principles as those described above for confidentiality. For example, a person should retain some control of their personal information such as who sees it, how the information is collected and how the information is used.
Privacy, however, is much more than keeping information confidential. Privacy refers to a person being given space, being undisturbed and being unobserved in different situations. In elderly or aged care, this may mean being able to perform activities alone or independently and having your own personal space.
In aged care, privacy must be approached in the right way. Privacy is necessary and should be a priority in aged care because it makes sure that a patient’s moral requirements are maintained.
Privacy in aged care is often increasingly crucial due to the nature of the care provided. Care providers collect lots of personal information on elderly patients, including medical records, and there are often lots of people involved in their care, including third-party providers and family members.
When it comes down to it, aged care is ensuring that a person has a safe environment in which to see out their final years of their life. As such, it is of utmost importance that the person receiving care maintains their sense of privacy as well as the feeling of being in control over the way they live and who they share things with.
What is an aged care worker’s duty of care?
Those who work in care settings should be familiar with their duty of care. Such workers have a professional and legal obligation to protect those in their care. A care worker’s duty of care includes assessing a person’s status in many ways: physically, psychologically, medically, socially and culturally. It is also within an aged care worker’s duty of care not to work beyond their capabilities or competencies. Likewise, they should not take matters into their own hands if this lies beyond their role.
Aged care workers need to be able to manage an elderly person’s privacy and confidentiality as a part of their duty of care as well as identifying any risks or threats to the elderly person’s health and wellbeing to maximise their quality of life.
What legislation covers privacy and confidentiality in aged care?
Confidentiality is not typically codified by legislation in UK law. The HSCIC Guide to Confidentiality 2013 states that common law confidentiality is “built up from case law through individual judgments”. The main principle that it outlines regarding confidentiality is that information should not be used or further disclosed except as understood originally by the confider or later with their permission.
Judgments have established that there are certain instances where confidentially can be breached (such as when it is ‘in the public interest’); this has been considered on a case-by-case basis in exceptional circumstances. Legislation can also override or set aside common law confidentiality.
Let us look at what the legislation has to say about privacy and confidentiality and how this applies to aged care.
The Human Rights Act 1998
The Human Rights Act maintains that every individual in the UK has the right to respect for their private and family life. As such, this includes personal information that is confidential. However, this is not an absolute right and can be overridden where necessary in instances where there is a safeguarding concern, for example.
The Care Act 2014
The Care Act promotes caregivers to have a person-centred approach to safeguarding others such as vulnerable adults in aged care. It also explains the value of sharing information where necessary as early as possible to keep people safe.
The Health and Social Care Act (Safety and Quality) 2015
This Act outlines provisions regarding the safety of health and social care services in England. It also includes the provision of the integration of information relating to users of those services and about how information relating to individuals for the purposes of providing such care is shared.
The GDPR and Data Protection Act 2018
Whilst these are separate regulations, they both explain how organisations should handle information, including in care settings. Under both the GDPR and Data Protection, everybody who uses personal data in any way must follow the data protection principles.
This means they must ensure that any information is:
- Used in a fair, lawful and transparent way.
- Used for a clear, specific purpose.
- Used adequately in a limited way and only when relevant or necessary.
- Accurate and kept up to date where necessary.
- Only kept for as long as is necessary.
- Processed securely including protection against unauthorised or unlawful use, access, damage, destruction or loss.
Sensitive information has even stronger protection legally.
Sensitive or special category data includes information on a person’s:
- Race and ethnicity.
- Political opinions.
- Genetics and biometrics (as a tool of identification).
- Sex life or orientation.
As is clear with the above legislation and regulations, information in aged care is (or should be) well protected. The legislation should, therefore, provide reassurance that confidentiality and privacy are maintained as far as possible when it comes to aged care.
When can you disclose private and confidential information in aged care?
It should be noted that there is no absolute confidentiality in aged care or any other form of health and social care. A common concern of aged care is often in the form of questions like “Am I allowed to disclose this information about a patient?” or “Am I breaching confidentiality by expressing concern about this person?”.
Sometimes, breaking confidentiality is in the elderly person’s best interests, or in the best interests of another person whose needs supersede those of the elderly person in a certain situation.
A care worker or health care practitioner may override privacy and confidentiality if they believe that an elderly person is at risk of harm or if they believe that the person is at risk of harming someone else. Concerns such as these must always be passed on to an appropriate person such as a safeguarding professional or supervisor.
Let us look at an example scenario.
A care worker visits an elderly lady whose usual carer is on annual leave. The carer notices that the elderly person has a wound that has become infected as it has not been cleaned or dressed appropriately. When enquiring about this, the elderly patient states that the usual carer has not changed the dressings for some time as she has been too busy, but she does not want the carer to get into trouble and has asked you not to report it or say anything to anyone.
In this instance, there is an obvious conflict between supporting the elderly patient and abiding by her wishes for confidentiality. To resolve the situation, there is only one possible option and that is to override the duty of confidentiality to ensure that the lady is protected from further harm.
Indeed, if the care worker failed to report this incident to a supervisor, they themselves could be considered neglectful in their care. To put it simply, if there is any doubt about what someone in this situation should do, the solution is always to seek advice from a supervisor or the person responsible for safeguarding.
How do you maintain privacy and confidentiality in aged care?
As should now be clear, maintaining privacy and confidentiality in aged care is of utmost importance.
To be able to do this efficiently and to meet the necessary legislation, there are a few practices that those involved in aged care can follow or use:
- Frequent training and raising awareness of privacy and confidentiality for those involved in aged care such as care workers, nurses, doctors, social workers and medical centre workers.
- Robust policies and agreements regarding privacy and confidentiality, ensuring they adhere to requirements and regulations.
- Sharing privacy and confidentiality policies with all stakeholders, including those receiving aged care.
- Implementing secure storage processes for data including security measures.
- Well-designed facilities and rooms for those in residential aged care settings that maximise privacy.
- Restrictions or limitations for the use of electronic devices such as smartphones.
- Upholding standards in care such as politeness, a positive demeanour and professionalism at all times.
- Asking those receiving aged care to consent to be touched in any way.
- Allowing those receiving aged care or those in a residential facility to have control over their personal belongings and space.
The importance of privacy and confidentiality in aged care
In sum, maintaining privacy and confidentiality in aged care is essential as not only is it a legal obligation in many respects, but it also builds trust between older people in care and their care workers.
When care is person-centred, elderly people’s needs are met and their personal circumstances can be acknowledged. In doing so, information between the elderly person and their carers can flow more freely, allowing for improved understanding and care. If older people trust their carers with their information, the foundations exist for improved and more effective care.