Department heading

It is estimated that 2.7 - 19.4% of all older people experience emotional, physical or sexual violence, neglect, deprivation of liberty or material exploitation. The need for care is associated with increased vulnerability. Violence can originate from family caregivers.

Exact data are not available due to different operationalisations of the concept of violence as well as methodological difficulties in field access. The risk of violence by family caregivers depends on the relationship between the person in need of care and the caregiver, the type and severity of the need for care, illnesses of the caregiver, cognitive impairments of the person in need of care and the social network.

Due to care counselling or outpatient services, care professionals have access to the home environment of persons in need of care, provided they receive benefits according to SGB XI. Therefore, they can play a key role in recognising, addressing, documenting and referring violence by relatives.

The confidence of care professionals from outpatient care or care counselling in dealing with suspected violence against people in need of care should therefore be increased. It was of interest how care professionals can be supported in the task of recognising, responding, documenting and forwarding. Care structures that support or hinder the sustainable implementation of measures to protect against violence in outpatient care should be identified.

1. Assessment tools and recommendations for action were systematically researched in international databases and checked for their transferability to the German care context.
2. Suitable intervention strategies were developed in interviews and focus group discussions with nursing staff and actors from the care sector.
3. In outpatient care services, training was conducted on how to deal with suspicious circumstances.
4. A recommendation for action for outpatient care services with a documentation sheet for recording suspicious findings in home care situations was developed in a consensus process.
5. A guideline for the successful implementation of the recommendation for action in outpatient care services was prepared.

Outpatient care services are caught between the goals of ensuring the well-being of their clients while acting in a legally correct and economical manner. Care workers are thereby confronted with situations in which they wonder whether those in need of care are being cared for appropriately. At the same time, they do not want to raise unjustified suspicions. Interventions are therefore often late and not always successful.

If the violence is the result of professional or emotional excessive demands, care services can react with their own measures, e.g. offer counselling or recommendations to expand the range of services. Recommendations and checklists are available on how to act within an outpatient care service in order to recognise risks of violence and experiences of violence and to develop appropriate strategies for dealing with them.

If care services or care counsellors reach a point where internal measures are no longer effective, the chain of action often breaks down. There are uncertainties about responsibilities and doubts about the success of the measures.

A prerequisite for any communication with external actors is careful, non-judgmental documentation of observations.

Responsibilities for prevention and intervention of violence by family caregivers are not regulated in Germany. For long-term care counsellors, long-term care insurance funds are structurally suitable as contact persons. However, the conversion of services by the long-term care insurance fund does not have to be accepted by the relatives and is not always target-oriented. In Hesse, the Hessische Betreuungs- und Pflegeaufsicht (HBPA) has been a contact for care professionals since 2012. It has the legal mandate to monitor the quality of care provision. Both bodies can coordinate measures and, if necessary, involve other actors.

Care services are obliged to maintain a quality management system and to comply with the obligation to provide evidence. The obligation to provide evidence is perceived as an obstacle to nursing work. This inhibits the motivation to introduce innovations that nursing services are not obliged to do.

Nevertheless, integrating a procedure for dealing with risks of violence and suspicion of violence into the service's quality management system offers opportunities for sustainable implementation and reliable dissemination of contents on violence prevention in the routines of action.