Elderly relative, hopsital, care home & photographs [poss triggering]

[Lellaworried]

I have an elderly relative who lives a good distance away. I and my sibling have POA for finances but not for health.
Relative has dementia which they did not have when POA was drawn up but has since developed meaning we have none for healthcare etc.

Relative has lived in a care home for several years following incidents of falls and wandering in their own home/area.
On admission, photographs were taken of the relative, with consent, showing face, which had an inury as a result of a fall at this time.
It is, I understand, policy for care home to log and photograph injuries that are sustained by residents following any falls. I have no real problem with in principle.

Some months ago relative had a skin complaint around the chest area and was prescribed an anti-fungal cream. Shortly after this, relative had a fall and was taken to hopsital after sustaining a head injury. During the course of the stay, relative was catheterised. Catheter remained in for a few days after relative was returned to care home.
There have been no falls since and at the time the above incidents occurred, I was informed of the injury, and asked if I was able to come to hospital (I was not).

Both myself and sibling have visited relative since and found them to be in as good health as can be expected for someone of their age and with their known health conditions- which include dementia and alzheimers.

Relative has just been admitted to hospital with an illness. Hopsital contacted me about arrangements if relative were to take a turn for the worst and that is all covered. However, I understand from my sibling that the hospital have been in touch again to ask if sibling knew that there were photographs of 'all of relatives body' including 'private areas' on the file. These photographs are allegedly recently dated (last fortnight).

I need to speak to my sibling before doing anything else but wtf? I can't begin to understand why these photographs would have been taken or by whom.

What do I do?

I have a small child at home and am sitting on my hands to stop me phoning the care home and demanding an immediate meeting with the manager.

They could have been taken if your relative has/had a skin condition or bruising or anything whatsoever that's different or a concern in that area.

If a carer noticed something while washing them, a senior would have been informed, and a photograph could have been taken to document it (much like when an injury is sustained). You wouldn't believe the paper trail care homes need for what we would consider 'minor' things - particularly when the resident has dementia and cannot communicate about the affected area.

The buttocks are one of the commonest places for pressure sores and many skin conditions can affect the vulva area, so there may well be perfectly legitimate reasons for the photos. OTOH, the hospital - which will admit many care home patients - clearly thinks this is unusual enough to contact your DSis.

I would be asking questions, but not assuming there is anything wrong until I hear the Care Homes' side of story.

I imagine it will be as the above poster suggested, documenting injuries. (However in my experience, any injuries were documented by drawing the location on a body map and describing them.)

If someone has a pressure sore, for example, photos are sometimes taken (with informed consent) to allow for comparison, and to ensure healing is taking place - especially with a high turnover of staff, who may be unfamiliar with the wound. This would be held in a wound care plan, with measurements/details of the dressings being used etc. It's not unusual to do this.
As mentioned, it is policy for the home to document any injuries. People with dementia do tend to wander, and falls are a hazard of this. If your relative is incontinent they may have sore skin, and this may be documented, in line with the home policy. If your relative is having frequent falls then I'd suggest looking at this, and at ways they can be kept safe. Older people are at greater risk of fractured hips, with the risks they carry.
I would set up a meeting, go in calmly, and review what's been happening.

photographs of 'all of relatives body' including 'private areas' on the file

What file?

If these photos were taken by the care home then it was presumably with good intention or they wouldn't have handed them over to the hospital. Hospitals don't automatically have access to care home documentation. If the photos are on the NHS hospital system, then were they taken during the last admission? In which case, the care home night not know about them.

sitting on my hands to stop me phoning the care home and demanding an immediate meeting with the manager

Just phone and ask what they know about this, or phone and ask for a meeting. Or phone the hospital yourself and ask them to be specific about what / when / why. You're not going to get any real answers via mumsnet.

I think the fact that the hospital has asked you that means that they are too concerned.

If the hospital are concerned they will report it through the appropriate channels.

Just had an update from sibling who has been to hospital to see relative (unconscious following a stroke, with other complications).

Hospital were given relatives' file by care home. File contains all information about relative & medical condition.

Hospital were very concerned about the nature of the photographs as there was, they say, no reason to have taken them. The photograph was annotated with a comment which on its own would have been, in the opinion of the hospital, adequate for a file.

Sibling and I were not informed that relative had had an issue with the area photographed (we are always updated in the event of GP being called, UTI, falls etc). So we were not aware of any potential problems health wise.

Hospital have reported to SS and advised sibling that care home are under investigation.

With regards to comments above I agree that photographs would be taken of injuries/pressure sores with good intention.
I completely understand that care homes are under a lot of pressure to deliver a high standard of care to residents and must be able to document injury, treatment etc.

However - there is a concern regarding to consent. When relative was admitted, we consented to photographs being taken to identify resident. We were aware that injuries would be photographed.
We did not give consent for any other photograps, and relative most certainly cannot do so.
There is also a question as to how the care home thought his was appropriate (given that a note on a 'body map' would be sufficient) and also why they did not inform sibling or I of any concerns of any infection/injury to relative's genital area.

Right now my major concern is if my relative is going to get through the stroke & illness presenting.

Going forward, there does need to be a satisfactory explanation explicity around the issue of consent and appropriateness of photographs. I'll be speaking to the hospital tomorrow to get a progress (health) update on relative, and will ask exactly what steps will be following their report.

To add to the essay above, obviously, sibling & I are concerned that relative may have been photographed without consent - regardless of good intentions.

We have never had any concerns about relative during the time they have been residing at the home; communication has always been good, and visiting can take place at any time. The fact that the photographs are in the file suggests that the care home do not consider them inappropriate to procedure.

Depending on outcomes/follow-ups, I may need to pull this thread, but I don't think our concerns are unjust per se. I suspect this is a case of ill-thought through documentation of medical concerns.

I should be clear that I am not seeking to drag any organisation through the mud, nor to seek 'damages' - I want to understand what has happened, and why.

I wonder whether, if there was a concern about skin in one area of the body, they felt the need to record that other areas were clear of the condition?

If a safeguarding referral has been made then the safeguarding team at Social Services will be deciding whether there has been harm/there is a risk of harm re. the photographs and whether this warrants a formal safeguarding enquiry. You might want to contact Social Services tomorrow morning (just google the number, you'll get through to the duty desk, make sure they know your and your sibling's relationship with the person), and ask if you can be put in touch with the safeguarding team, shown all documentation etc. They do these enquiries all the time, are on the spot, and will know the general reputation of the home. (google Section 42 safeguarding enquiry for more info).

You might want to call the home tomorrow morning anyway, if it's a nursing home then I'd suggest you ask to speak to the clinical lead or lead nurse rather than the general manager.

There's a high chance it will have been to 'prove' that any pressure damage occurred in hospital and not at the care home.

Care homes are usually (but not always) much better at preventing pressure sores than hospitals. It's not uncommon for hospitals to return residents back to care homes with pressure sores that weren't there prior to admission. It may be that the care home has had problems with this particular hospital trying to blame them and is taking 'proof' that the pressure sores weren't pre-existing before admission.

It's really not great practice if it's being done routinely and I wouldn't like it if it was my relative but I can understand their thinking behind it.

The only possible explanation I can think of would be that the care home did body photos before she went to hospital as a record of how her body looked with regard to sores/ skin damage when she left them. If a patient is admitted from a care home and is noted to have skin damage on admission it is likely going to result in a safeguarding referral. By photographing her body perhaps they were trying to evidence she had nothing wrong to the hospital. I am not suggesting its the right thing to do but might be worth considering. If she lacks capacity to consent to this then they could argue it was a best interest decision under the Mental capacity act ( you said you don't have poa for health and welfare) but good practice is to talk to you. As the nearest relative you don't automatically get to be the decision maker as some relatives don't always act in best interests. I suspect this will turn out to be over cautious practice by the care home who fear being accused of neglect rather than anything sinister.

Cross posted!

there is a concern regarding to consent

Under the Mental Capacity Act 2005, no one can give consent on behalf of another adult unless there is a welfare Lasting Power of Attorney or a court-appointed advocate. The Care Home staff have a duty to act in the best interests of their resident and, provided they have done so, they did not need to seek your consent.

I would also caution that most hospital nurses have never worked in a care home and will not be familiar with what the normal standards for documentation are.

It is clearly absolutely right that this is investigated, but I would try to stay neutral until you know more.

If the relative was unable to give consent then the care home will have made a decision to take the photos "in their best interest" (simply having dementia does not remove a persons ability to make decision, capacity is time and decision specific).

Photos of injury are common this includes pressure wound photos to vulva, groin and sacrum (bum). They may have been taken to confirm skin integrity prior to admission as hospitals are buggers for claiming pressure wounds were present prior to admission when they weren't.

What you have described would not raise alarm bells to me unless their are issues not described.

For reference I am a social worker for older adults.

A relative of mine used to own a care home and I would agree with PP above - it's quite common for these photos to be taken prior to a hospital admission in case the resident develops pressure sores while in hospital. The cynic in me wonders if the hospital have raised it because the practise isn't great from their perspective because it leads to greater accountability. Pressure sores really are frighteningly easy to develop. That said, my understanding is that the patient should always consent to these photos and if you feel your relative would be unable to consent I would also be concerned and would raise it with them. It's vanishingly unlikely to be anything sinister, as if it was they would hardly put them in the file and submit to the hospital willingly.

Just to clarify - the phographs are not of pressure sores, and they were taken the week before relative was taken ill. At the time they were taken there was no indication that relative would need to be hospitalised.

Peach I think what you say in the later part of your post is likely correct. The issue of consent here is the very grey area. I will of course be following this up but at present my primary concern is the wellbeing of my relative. Things are not looking particularly rosy right now and I'm struggling with guilt over being unable to currently find a time that I can actually go to visit (other factors limiting my ability to get there, but irrelevant to the points made in this thread).