Good care and mistreatment in healthcare facilities: a major societal issue

The issue of proper care and mistreatment within healthcare facilities has become a major societal concern in France. Despite the numerous quality improvement initiatives that have been implemented, a significant portion of the population remains concerned about the risk of mistreatment for themselves or their loved ones. This guide to improving practices from the HAS (French National Authority for Health), approved on October 3, 2024, aims to promote the dissemination of best professional practices in the health, social care, and social sectors by providing common benchmarks for a better understanding of these complex and subjective concepts. It is intended for all professionals working in these facilities, recognizing that respectful treatment and the fight against mistreatment are everyone’s responsibility. [Image: A caregiver gently holds the hand of an elderly person, smiling.] src="https://cdn.prod.website-files.com/61f1c5bbc327ec3679e7457c/67d94162982298f0b07092ba_700b0c828ab74ee2ff8f9d471b389e8a7ed5b3085f284f01dbd6f7774caa6885.png" width="auto" height="auto" loading="auto">

Understanding the fundamental concepts: positive treatment and mistreatment

The distinction between appropriate care and mistreatment is crucial for guiding practices and policies within healthcare facilities.

Mistreatment, as legally defined in Article L. 119-1 of the French Social Action and Families Code (CASF), which has been in effect since 2022, applies to any person in a vulnerable situation when a gesture, word, action, or inaction compromises or harms their development, rights, fundamental needs, or health, within the context of a relationship of trust, dependence, care, or support. It is important to note that mistreatment can be occasional or ongoing, intentional or unintentional, and originate from an individual, collective, or institutional source. Violence and neglect can manifest in multiple and combined forms. There are seven types of mistreatment:

• Physical
• Sexual
• Psychological
• Material and financial
• Neglect, abandonment, or deprivation
• Discrimination
• Exposure to a violent environment

It is essential to distinguish between mistreatment and violence. Mistreatment implies a helping relationship between the person and the perpetrator, while violence occurs in the absence of such a relationship (for example, between two people in care or among professionals themselves).

Positive treatment, on the other hand, is a positive and holistic concept. It involves providing care to the person and their support network that meets their expectations and needs, while ensuring respect for their rights and freedoms. Positive treatment is a culture that guides individual actions and collective relationships within an institution, aiming to promote the well-being of the person while remaining mindful of the risk of mistreatment. It involves: Personalizing support; Informing the person of their rights; Assessing their communication needs; Ensuring that the action meets their expectations; Supporting autonomy; Working “with” and not “for” the person; Regularly reflecting on practices; Respecting fundamental rights; Maintaining a social, cultural, and family life; and Building alliances with caregivers and representatives. Users

Meaningful human interaction is central to building trust and satisfaction among all stakeholders.

The challenges of mistreatment and the fundamental importance of positive treatment

Preventing mistreatment in healthcare facilities raises numerous issues that affect individuals, institutions, and society.

Societal challenges

• An aging population and an increase in the number of vulnerable people
• Widespread public concern about the risks of abuse

Quality and safety challenges

• Risk prevention and signal management
• Certification and evaluation of healthcare facilities Social and medical-social establishments and services (ESSMS)

Public health issues

• Harmful consequences of mistreatment (depression, cognitive decline, premature death)
• There is a need to train professionals to better identify and prevent these situations

Ethical issues

• Reflection on the autonomy and self-determination of those receiving care

Legal issues

• Respect for the fundamental rights of vulnerable people
• Legal obligations of establishments

Political issues

• National Strategy to Combat Abuse
• Policy on Healthy Aging and Independence

Positive treatment is not merely the absence of mistreatment; it constitutes a comprehensive and proactive approach aimed at promoting respect for the rights and freedoms of service users from the moment they are admitted.

Identifying and preventing instances of mistreatment: a collective commitment

Identifying and preventing instances of mistreatment requires the involvement of all staff members at every level of the organization.

Risk factors

• Related to the residents
• Related to staff (lack of training, excessive workload, deteriorating conditions)
• Related to the facility and environment

Early warning signs

• Sudden changes in behavior and mood
• Sudden deterioration in health
• Complaints from the resident or their family

All signs must be taken seriously, reported to management, and documented in the resident's file.

Implementing respectful care: principles translated into concrete actions

Ensuring freedom of choice and empowering residents and those receiving care

• Involve the person in decisions
• Promote their autonomy and self-determination
• Ensure that they understand their rights from the moment they arrive

Help professionals reflect on their practices

• Continuing education
• Lessons Learned Sessions
• Spaces for team discussion

Engage the entire institution

• Incorporate this commitment into the institution's mission statement
• Identify positive care coordinators
• Promote a culture of reporting

The Key Role of Reporting and Addressing Signs of Abuse

Reporting any instance of abuse or warning signs is a crucial step.

Legal Obligations

• Professional secrecy is waived in cases of proven abuse
• Requirement to report to the competent authorities

Internal Procedure

• Notice to management
• Safety of the victim
• Analysis of the facts and implementation of corrective actions

Lessons Learned (RETEX): A tool for learning and continuous improvement

Lessons learned (RETEX) allow us to take a step back and identify the root causes of cases of mistreatment.

Analytical methods

• ALARM method
• Lessons Learned Meetings

Objectives

• Identify areas for improvement
• Implement preventive measures

Institutional Commitment: Evaluation and Perspectives for a Sustainable Culture of Positive Treatment

Institutions must ensure:

• Strict management of reports
• Monitoring of action plans
• Ongoing evaluation of practices
• Regular training for professionals

Continuous improvement of practices and investment in training are essential tools for ensuring high-quality, respectful support for everyone.

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Source: HAS

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