This chapter provides information for multi-agency practitioners about carers of adults with care and support needs in relation to adult safeguarding. Specifically, it outlines their role in preventing and detecting abuse or neglect of those for whom they care, but it also discusses potential harm that may be caused by carers. Multi-agency practitioners need to be aware of such possible risks to adults with care and support needs.
This chapter was added to the APPP in July 2018.
A carer, in this context, is usually a family member or a friend.
Carers can play a significant role in preventing and detecting abuse and neglect for the people they care for. The vast majority of carers strive to act in the best interests of the person they support. There are times, however, when carers themselves experience abuse from the person to whom they are offering care and support or from the local community in which they live.
Risk of harm to the supported person may also arise because of carer stress, tiredness, or lack of information, skills or support (see Carers: Preventing, Delaying or Reducing Needs). Also, there are times where harm is intended.
Circumstances in which a carer could be involved in a situation that may require a safeguarding response from agencies include:
- a carer may witness or speak up about abuse or neglect in relation to the adult they care for, or another person;
- a carer may experience intentional or unintentional harm from the adult they are trying to support, or from professionals and organisations they are in contact with;
- a carer may harm or neglect the adult they support on their own or with others. This may, or may not, be deliberate.
Where there is intentional abuse, adult safeguarding under the Care Act should always be considered.
All staff and professionals should support a rights based approach to issues of abuse and neglect and to the recognition and support of carers.
Work developed by the Association of Directors of Adult Social Services (ADASS), carers groups, commissioners and organisations working with carers, identify six distinct areas related to carers and safeguarding:
- partnership working;
- information and advice;
- role of carers in strategic planning.
2. Partnership Working
Carers have a wealth of information and knowledge about the person that they support. As well as raising concerns, carers are able to support safeguarding enquiries by sharing information and are valued partners in such enquiries. Their views may hold the key to protecting people. If a carer speaks up about abuse or neglect, it is essential that they are listened to and appropriate enquiries made carers may identify and mitigate risk and act as advocates. The lessons from Transforming Care (Local Government Association https://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/transforming-care) and other public inquiries need to be taken forward in viewing carers as equal partners unless there are valid reasons not to.
Where the adult lacks capacity, carers may reasonably provide professionals with the outcome they consider the adult at risk would want, as they know the persons likes and dislikes, what relationships are important to them and what relationships they may find difficult. Consideration for the carer and adult in safeguarding plans, in for example family conferences that have their own dynamics, need to take into account conflicting views as carers may not want the same outcome as the adult they are supporting (see Stage 3: Plan / Review).
‘If a carer experiences intentional or unintentional harm from the adult they are supporting, or if a carer unintentionally or intentionally harms or neglects the adult they support, consideration should be given to whether, as part of the assessment and support planning process for the carer and, or, the adult they care for, support can be provided that removes or mitigates the risk of abuse.’ (Chapter 14, Care and Support Statutory Guidance).
3.1 Information and Advice
See also Information and Advice chapter.
Carers need to know how they can find support and services available in their area, and be able to access advice, information. Carers need to know, that they can raise a concern in a safe environment and be confident that their concerns will be acted upon. It might be that people are unaware that the actions that they take could be perceived by others as abusive. For example, someone with a learning disability entitled to state benefits to meet their living expenses, and to have money as part of their access to leisure and other personal requirements may have this controlled by a family member.
Carers should have access to information and advice in a way that is meaningful to them and may themselves be in need of care and support and need to know how they can access services. See also Support and Care for Adults, South Tyneside Council.
The Care Act includes protection from abuse and neglect as part of the definition of wellbeing (see Promoting Wellbeing). As such, a needs assessment for the carer’s assessment is an important opportunity to explore the individuals’ circumstances and consider whether it would be possible to provide information or support that prevents abuse or neglect from occurring. This may be for example, by providing training to the carer about the condition that the adult they care for has, or to support them to care more safely. Where that is necessary the local authority should make arrangements for providing such interventions.
The carer’s assessment is distinct from a needs assessment. Safeguarding should always be at the forefront of assessments. Professionals need to be candid with carers about the risks that a carer’s assessment may identify for either preventing the need for safeguarding to them, or preventing the risk of the carer abusing the person that they are caring for.
Whole family assessments might also be considered using the framework of Think Family as an appropriate way forward. Working collaboratively with other agencies, carers may also receive support from a number of agencies.
4. Safeguarding Enquiries
If a carer raises any issues about abuse or neglect, it is essential that they are listened to and that, where appropriate, a safeguarding enquiry is undertaken and other agencies are involved as required.
Families, who view individual benefits as part of the family income, may not view their actions as abusive, but where the adult they are supporting has little or no choice about how their money is spent, this could be seen as financial abuse by others. Where carers may have acted in a way that constitutes abuse staff should respond according to adult safeguarding procedures so that the adult is safeguarded appropriately. Whilst there may be mitigating circumstances to take into consideration the wellbeing and safety of the adult should be paramount.
If a carer experiences intentional or unintentional harm from the adult they are supporting, or if a carer unintentionally or intentionally harms or neglects the adult they support, consideration should be given to:
- removing or reducing risk – whether, as part of the assessment and support planning process for the carer and / or the adult they care for, support can be provided that removes or reduces the risk of abuse. This may include, for example, the provision of training, information or other support that minimises the stress experienced by the carer. In some circumstances the carer may need to have independent representation or advocacy (see Independent Advocacy); in others, a carer may benefit from having such support if they are under great stress;
- involving other agencies – whether other agencies should be involved: in some circumstances where it is possible a criminal offence has been committed this will include alerting the police, or in others the primary healthcare services may need to be involved in monitoring the situation.
Other key considerations for carers should include:
- involving carers in safeguarding enquiries relating to the adult they care for, as appropriate;
- whether or not a joint assessment of the adult and the is appropriate in each individual circumstance;
- the risk factors that may increase the likelihood of abuse or neglect occurring;
- whether a change in circumstance changes the risk of abuse or neglect occurring.
A change in circumstance should also trigger the review of the care and support plan and, or, support plan (see Care and Support Planning). Further information about these considerations can be found in Carers and Safeguarding: Working Together to Improve Outcomes (ADASS, 2011).
In some instances, the most appropriate person to support the adult and act as an advocate is the primary carer. Where the carer is acting in the role of advocate, they may need support to do so, therefore professionals need to provide information and ensure that it is understood. The carer themselves may be in need of an advocate. For example, where there are safeguarding concerns about an older person with their own care and support needs caring for a partner with dementia. Assumptions should not be made about carers acting as advocates or being in need of advocacy and each case should take account of the personal circumstances.
Advocacy can be helpful in all kinds of situations when the adult or their carer is finding it difficult to have their opinions and choices heard. There are numerous advocacy services that can offer support depending on the individual’s circumstance and the outcomes they wish to achieve.
Community Advocacy services refers to all advocacy that is not a legal entitlement and offers support with a range of situations. Organisations such as POhWER, SEAP and VoiceAbility can all offer further advice.
Advocacy for a specific cause is offered by charities and organisations which can provide advocacy for a specific issue. Examples include Shelter who offers advocacy for people experiencing housing problems and Coram Voice who offers mental health advocacy for young people in care.
Group advocacy (also known as collective advocacy) is where a group of people with similar experiences meet to support each other and collectively strengthen their voice. Mental health charities, like the National Survivor User Network for Mental Health (NSUN), has a network of mental health service user groups across the UK, as well as Mind and Mind’s Infoline.
Peer advocacy: Peer advocates have lived experience of a mental health problem and can offer support to help adults cope with a range of problems.
Statutory advocacy offers a legal entitlement to advocacy in certain circumstances. There are three types of statutory advocates in England and Wales: Independent Mental Health Advocates (IMHAs), Independent Mental Capacity Advocates (IMCAs) and advocates supporting people under the Care Act 2014. See Independent Advocacy for further information.